Healthcare Provider Details

I. General information

NPI: 1770750978
Provider Name (Legal Business Name): KEVIN MATTHEW DELGADILLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 EL CAJON BLVD
LA MESA CA
91942-6712
US

IV. Provider business mailing address

7862 EL CAJON BLVD
LA MESA CA
91942-6712
US

V. Phone/Fax

Practice location:
  • Phone: 619-644-6452
  • Fax: 619-466-7528
Mailing address:
  • Phone: 619-644-6452
  • Fax: 619-466-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: