Provider Demographics
NPI:1912028036
Name:KNAPP, DELPHINA I
Entity Type:Individual
Prefix:MRS
First Name:DELPHINA
Middle Name:
Last Name:KNAPP
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DELPHINA
Other - Middle Name:
Other - Last Name:KNAPP
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:BACHELORS DEGREE
Mailing Address - Street 1:14517 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3144
Mailing Address - Country:US
Mailing Address - Phone:310-217-9550
Mailing Address - Fax:310-217-9551
Practice Address - Street 1:2320 W 149TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-217-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor