Provider Demographics
NPI:1306478896
Name:DELARA, KAROLJOHN SIMPAUCO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KAROLJOHN
Middle Name:SIMPAUCO
Last Name:DELARA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1692 FLEISHBEIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2931
Mailing Address - Country:US
Mailing Address - Phone:850-292-7234
Mailing Address - Fax:619-404-4113
Practice Address - Street 1:1692 FLEISHBEIN ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-4332
Practice Address - Country:US
Practice Address - Phone:850-292-7234
Practice Address - Fax:619-404-4113
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95013929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily