Provider Demographics
NPI:1073632295
Name:DELREYES, DIANNE M (LAC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:DELREYES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2531
Mailing Address - Country:US
Mailing Address - Phone:503-515-7043
Mailing Address - Fax:
Practice Address - Street 1:800 FRANKLIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3355
Practice Address - Country:US
Practice Address - Phone:360-693-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist