Provider Demographics
NPI:1982496717
Name:DELAO, JORGE LEONARD
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LEONARD
Last Name:DELAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93061-0106
Mailing Address - Country:US
Mailing Address - Phone:805-515-9944
Mailing Address - Fax:
Practice Address - Street 1:10475 SULPHUR CASCADE RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-9569
Practice Address - Country:US
Practice Address - Phone:805-515-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC377740101YM0800X
CAMFC377740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health