Provider Demographics
NPI:1609663632
Name:FORNARIS, DEILYS ADRIAN
Entity type:Individual
Prefix:MR
First Name:DEILYS
Middle Name:ADRIAN
Last Name:FORNARIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S PLEASANT AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3510
Mailing Address - Country:US
Mailing Address - Phone:209-683-8632
Mailing Address - Fax:
Practice Address - Street 1:408 E PINE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2923
Practice Address - Country:US
Practice Address - Phone:209-683-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator