Healthcare Provider Details

I. General information

NPI: 1093276115
Provider Name (Legal Business Name): ADAM CLEMENTI DELGADO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSION BLVD STE 2800
JACKSON CA
95642-2536
US

IV. Provider business mailing address

100 MISSION BLVD STE 2800
JACKSON CA
95642-2536
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-7615
  • Fax: 209-257-5856
Mailing address:
  • Phone: 209-257-7615
  • Fax: 209-257-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A22723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: