Provider Demographics
NPI:1255359667
Name:DALEY, SANDRA P (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:P
Last Name:DALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:MAIL CODE 0927
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:619-681-0764
Mailing Address - Fax:619-681-0666
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:MAIL CODE 0927
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-5004
Practice Address - Country:US
Practice Address - Phone:619-681-0764
Practice Address - Fax:619-681-0666
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G335830Medicaid
CAWG33583BMedicare ID - Type Unspecified
CA00G335830Medicaid