Provider Demographics
NPI:1831678879
Name:DELGADILLO, KENNA MARIA
Entity type:Individual
Prefix:
First Name:KENNA
Middle Name:MARIA
Last Name:DELGADILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W D ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3026
Mailing Address - Country:US
Mailing Address - Phone:909-983-9803
Mailing Address - Fax:
Practice Address - Street 1:950 W D ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3026
Practice Address - Country:US
Practice Address - Phone:909-450-2502
Practice Address - Fax:909-450-2637
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach