Healthcare Provider Details

I. General information

NPI: 1346851946
Provider Name (Legal Business Name): MYRTLE DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CENTER ST
MOBILE AL
36604-1542
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-5437
  • Fax: 251-410-4749
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.38485
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: