Provider Demographics
NPI:1508011404
Name:WILSON, DELSA TAPIA
Entity Type:Individual
Prefix:MRS
First Name:DELSA
Middle Name:TAPIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 42
Mailing Address - Street 2:
Mailing Address - City:ETIWANDA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-0042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5053 LA MART DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-369-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist