Provider Demographics
NPI:1912063975
Name:ELLIS, DELMAR DAVID (RN)
Entity Type:Individual
Prefix:MR
First Name:DELMAR
Middle Name:DAVID
Last Name:ELLIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TYRONE CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9365
Mailing Address - Country:US
Mailing Address - Phone:707-447-2279
Mailing Address - Fax:
Practice Address - Street 1:228 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4519
Practice Address - Country:US
Practice Address - Phone:707-553-5331
Practice Address - Fax:707-553-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537832163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health