Provider Demographics
NPI:1558729293
Name:BRANCH-MCLEMORE, DELORES ELESE
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:ELESE
Last Name:BRANCH-MCLEMORE
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 1:12422 ELVA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3248
Mailing Address - Country:US
Mailing Address - Phone:424-266-1393
Mailing Address - Fax:
Practice Address - Street 1:12422 ELVA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3248
Practice Address - Country:US
Practice Address - Phone:424-266-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner