Provider Demographics
NPI:1962519835
Name:DELIA, LOUIS F IV (PHD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:F
Last Name:DELIA
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 2ND ST
Mailing Address - Street 2:#106
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5011
Mailing Address - Country:US
Mailing Address - Phone:310-451-9100
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST
Practice Address - Street 2:#106
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5011
Practice Address - Country:US
Practice Address - Phone:310-451-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11153103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR62520Medicare UPIN