Provider Demographics
NPI:1578067864
Name:DEL REAL, KARINA ANN
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ANN
Last Name:DEL REAL
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 1:1309 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1332
Mailing Address - Country:US
Mailing Address - Phone:831-524-4437
Mailing Address - Fax:
Practice Address - Street 1:699 SERRAMONTE BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4132
Practice Address - Country:US
Practice Address - Phone:650-994-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist