Healthcare Provider Details

I. General information

NPI: 1043884778
Provider Name (Legal Business Name): JEANNESSE DELGADO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE
PHOENIX AZ
85007-3913
US

IV. Provider business mailing address

55 E RAY RD STE 5-C
CHANDLER AZ
85225-3337
US

V. Phone/Fax

Practice location:
  • Phone: 407-723-9788
  • Fax:
Mailing address:
  • Phone: 407-723-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number704PA
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8515
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: