Provider Demographics
NPI:1639464431
Name:AMOUSSOU, DELA (MD)
Entity Type:Individual
Prefix:
First Name:DELA
Middle Name:
Last Name:AMOUSSOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 SAMARKAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3770
Mailing Address - Country:US
Mailing Address - Phone:773-368-1306
Mailing Address - Fax:
Practice Address - Street 1:133 W. SANTA CLARA STREET
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-582-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1984902084N0400X
IAR-916282N00000X
CAA1360152084N0400X
FLTPME14422084N0400X
WAMD610365542084N0400X
NV173012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No282N00000XHospitalsGeneral Acute Care Hospital