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NPI Code Detail

MEDICARE: MR. GARY DELGADO

MEDICARE: MR. GARY 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578711537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY DELGADO
Provider Business Mailing Address
First Line : 4590 COVE ST
Second Line :
City : HEMET
State : CA
Zip : 92545-8954
Country : US
Telephone Number : 951-306-2837
Fax Number :
Provider Business Practice Location Address
First Line : 14700 MANZANITA RD
Second Line :
City : BEAUMONT
State : CA
Zip : 92223-3026
Country : US
Telephone Number : 951-845-3155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2008
Last Update Date : 05/23/2019

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