Provider Demographics
NPI:1649325762
Name:DELCOLLO, DANIEL PHILIP (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILIP
Last Name:DELCOLLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 ARROWROOT CIR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-3724
Mailing Address - Country:US
Mailing Address - Phone:302-893-2486
Mailing Address - Fax:
Practice Address - Street 1:2350 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-920-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18614363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical