MEDICARE: JORGE MANUEL DELGADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1528504123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE MANUEL DELGADO

Provider Business Mailing Address
First Line	:	6606 SW 131ST PATH APT 1807A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5629
Country	:	US
Telephone Number	:	786-597-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 SW 131ST PATH APT 1807A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5629
Country	:	US
Telephone Number	:	786-597-3576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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