Provider Demographics
NPI:1861680381
Name:DELALOZA, EDWARD L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:DELALOZA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13272
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-3272
Mailing Address - Country:US
Mailing Address - Phone:844-724-7365
Mailing Address - Fax:844-724-7365
Practice Address - Street 1:4445 EASTGATE MALL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1979
Practice Address - Country:US
Practice Address - Phone:844-724-7365
Practice Address - Fax:844-724-7365
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 214151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical