Provider Demographics
NPI:1992048516
Name:CONCHA, DELFINO M (AUD)
Entity type:Individual
Prefix:DR
First Name:DELFINO
Middle Name:M
Last Name:CONCHA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:DEL
Other - Middle Name:
Other - Last Name:CONCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:2431 CORAL CT
Mailing Address - Street 2:#1
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2838
Mailing Address - Country:US
Mailing Address - Phone:319-545-7125
Mailing Address - Fax:
Practice Address - Street 1:2431 CORAL CT
Practice Address - Street 2:#1
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2838
Practice Address - Country:US
Practice Address - Phone:319-545-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA482231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist