Individual
DELVICCIO MARCEL WATTS-FROST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
233 W BASELINE RD, LA VERNE, CA 91750
(909) 593-2581
Mailing address
233 W BASELINE RD, LA VERNE, CA 91750
(909) 593-2581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/05/2020
Last updated
07/13/2023
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