Provider Demographics
NPI:1629836747
Name:DELAHOUSSAYE, GINA SHANTAL
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:SHANTAL
Last Name:DELAHOUSSAYE
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 1:36285 TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9784
Mailing Address - Country:US
Mailing Address - Phone:619-654-2702
Mailing Address - Fax:
Practice Address - Street 1:36285 TOPAZ WAY
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9784
Practice Address - Country:US
Practice Address - Phone:619-654-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider