| Doctor Name: | JOSE MARIE CORNELIO DERLA |
| NPI Number: | 1386965754 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 041.359360 |
| Business Practice Address: | 2400 Michael Ave Zion, IL - 600999224 |
| Business Phone Number: | 2243539424 |
| Business Fax Number: | |
| Mailing Address: | 2400 Michael Ave, ZION |
| State: | IL |
| Postal Code: | 600999224 |
| Phone Number: | 2243539424 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2010 |
| NPI Last Update Date: | 06/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 041.359360 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |