Provider Demographics
NPI:1720025729
Name:PRICE, DELANE OWEN (PA-C)
Entity Type:Individual
Prefix:
First Name:DELANE
Middle Name:OWEN
Last Name:PRICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:LANE
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-614-9250
Mailing Address - Fax:805-614-9260
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-614-9250
Practice Address - Fax:805-614-9260
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP57449Medicare UPIN
WPA13405AMedicare PIN