Provider Demographics
NPI:1932841517
Name:D'ELIA, MAXX WOLF
Entity Type:Individual
Prefix:MR
First Name:MAXX
Middle Name:WOLF
Last Name:D'ELIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:D'ELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9015 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3673
Mailing Address - Country:US
Mailing Address - Phone:408-691-6840
Mailing Address - Fax:
Practice Address - Street 1:290 LOOF AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-846-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2023-10-13
Deactivation Date:2023-10-04
Deactivation Code:
Reactivation Date:2023-10-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator