Provider Demographics
NPI:1720520638
Name:DELSI, REBECCA MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:DELSI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:DELSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:11744 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3131
Mailing Address - Country:US
Mailing Address - Phone:970-209-3707
Mailing Address - Fax:
Practice Address - Street 1:2250 W LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-5050
Practice Address - Country:US
Practice Address - Phone:970-209-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05064062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer