Provider Demographics
NPI:1992103105
Name:HAREWOOD, DELIA
Entity type:Individual
Prefix:MS
First Name:DELIA
Middle Name:
Last Name:HAREWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1553
Mailing Address - Country:US
Mailing Address - Phone:510-433-1150
Mailing Address - Fax:510-452-8836
Practice Address - Street 1:6955 FOOTHILL BLVD
Practice Address - Street 2:SUITE 188
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2455
Practice Address - Country:US
Practice Address - Phone:510-746-5595
Practice Address - Fax:510-553-1223
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA774915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse