Basic Information
| Provider Information | |||||||||
| NPI: | 1659735637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELSHAD | ||||||||
| FirstName: | MITRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX AD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959921396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003130111 | ||||||||
| FaxNumber: | 5307511237 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 COHASSET RD | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303424395 | ||||||||
| FaxNumber: | 5308942325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 123438 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | A004603 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 95004787 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.