Basic Information
Provider Information | |||||||||
NPI: | 1225255417 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DI PELESI | ||||||||
FirstName: | FRANCIS | ||||||||
MiddleName: | LOUIS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8390 CHAMPIONS GATE BLVD | ||||||||
Address2: | SUITE 215 | ||||||||
City: | CHAMPIONS GATE | ||||||||
State: | FL | ||||||||
PostalCode: | 338968310 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073901677 | ||||||||
FaxNumber: | 4073901765 | ||||||||
Practice Location | |||||||||
Address1: | 400 30TH ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | OAKLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 946093318 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5106280949 | ||||||||
FaxNumber: | 5106280947 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2007 | ||||||||
LastUpdateDate: | 07/26/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY21140 | CA | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.