Provider Demographics
NPI:1700870383
Name:IREY, DELIA F (PA)
Entity Type:Individual
Prefix:MS
First Name:DELIA
Middle Name:F
Last Name:IREY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DELIA
Other - Middle Name:FARRELL
Other - Last Name:RASELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1111 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3131
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:760-446-8289
Practice Address - Street 1:1111 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:760-446-8289
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical