Provider Demographics
NPI:1619729779
Name:DELVA, PIERRE A
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:A
Last Name:DELVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 SW RENFRO ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1375
Mailing Address - Country:US
Mailing Address - Phone:786-985-7692
Mailing Address - Fax:
Practice Address - Street 1:2173 SE GASLIGHT ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7330
Practice Address - Country:US
Practice Address - Phone:786-985-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances