Provider Demographics
NPI:1285728253
Name:DELSE, FREDERICK C (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:C
Last Name:DELSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20045 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2353
Mailing Address - Country:US
Mailing Address - Phone:408-446-2817
Mailing Address - Fax:
Practice Address - Street 1:20045 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 2E
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2353
Practice Address - Country:US
Practice Address - Phone:408-446-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG214212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry