Provider Demographics
NPI:1619710878
Name:DELELLIS MEDICAL CORP.
Entity type:Organization
Organization Name:DELELLIS MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-886-8005
Mailing Address - Street 1:1401 21ST ST # 10366
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:619-272-8334
Mailing Address - Fax:
Practice Address - Street 1:1401 21ST ST # 10366
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:619-886-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty