| Doctor Name: | MS. MARIE TALLENT DELOACH |
| NPI Number: | 1508138660 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MT(ASCP) |
| License Number: | 03671395 |
| Business Practice Address: | 500 North Mundo Dulce, NM - 87528 |
| Business Phone Number: | 5757597252 |
| Business Fax Number: | 5757593532 |
| Mailing Address: | Po Box 187, 500 North Mundo DULCE |
| State: | NM |
| Postal Code: | 875280187 |
| Phone Number: | 5757597252 |
| Fax Number: | 5757593532 |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 02/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | 03671395 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |