Provider Demographics
NPI:1902677974
Name:DELMONTE, MARCO PAOLO S (PMHNP)
Entity Type:Individual
Prefix:
First Name:MARCO PAOLO
Middle Name:S
Last Name:DELMONTE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30450 HAUN RD # 1157
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6810
Mailing Address - Country:US
Mailing Address - Phone:517-243-7889
Mailing Address - Fax:
Practice Address - Street 1:30450 HAUN RD # 1157
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6810
Practice Address - Country:US
Practice Address - Phone:517-243-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028605363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health