Provider Demographics
NPI:1649960006
Name:DELGADO DIAZ, KELAIAH LILLIAN
Entity type:Individual
Prefix:
First Name:KELAIAH
Middle Name:LILLIAN
Last Name:DELGADO DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELAIAH
Other - Middle Name:LILLIAN
Other - Last Name:DERDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 COHASSET RD STE 180
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2460
Mailing Address - Country:US
Mailing Address - Phone:530-891-3277
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD STE 180
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2460
Practice Address - Country:US
Practice Address - Phone:530-891-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health