Provider Demographics
NPI:1578186458
Name:DESILVA, IMMACULATE P
Entity Type:Individual
Prefix:MS
First Name:IMMACULATE
Middle Name:P
Last Name:DESILVA
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 1:9727 CASA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3023
Mailing Address - Country:US
Mailing Address - Phone:661-246-6806
Mailing Address - Fax:
Practice Address - Street 1:9727 CASA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3023
Practice Address - Country:US
Practice Address - Phone:661-246-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program