Provider Demographics
NPI:1831863141
Name:DELUSSA, TINA TERESA (LVN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:TERESA
Last Name:DELUSSA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E MILL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3808
Mailing Address - Country:US
Mailing Address - Phone:559-853-6222
Mailing Address - Fax:559-339-2101
Practice Address - Street 1:89 E MILL AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3808
Practice Address - Country:US
Practice Address - Phone:559-853-6222
Practice Address - Fax:559-339-2101
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN237460164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse