MEDICARE: DR. ADA L DELGADO MATEO MD

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	2084P0800X	Psychiatry Physician	11110	PR

General Provider Information

NPI Number	:	1992795975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADA L DELGADO MATEO MD

Provider Business Mailing Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	SUITE 902
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-780-9212
Fax Number	:	787-785-9212

Provider Business Practice Location Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	SUITE 902
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-780-9212
Fax Number	:	787-785-9212

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/19/2013

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