Healthcare Provider Details

I. General information

NPI: 1699749515
Provider Name (Legal Business Name): ORLANDO A. DELGADO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108, SUITE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-3366
  • Fax: 602-933-4166
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2688
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2688
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: