Provider Demographics
NPI:1457524514
Name:RILEY, DELFINA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DELFINA
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4718
Mailing Address - Country:US
Mailing Address - Phone:626-574-1286
Mailing Address - Fax:626-574-1286
Practice Address - Street 1:1700 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-4718
Practice Address - Country:US
Practice Address - Phone:626-574-1286
Practice Address - Fax:626-574-1286
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6178363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP19757Medicare UPIN