Healthcare Provider Details

I. General information

NPI: 1194034959
Provider Name (Legal Business Name): ADOLPH THOMAS DELGADO MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 BASELINE RD BOX 400
LA VERNE CA
91750-2353
US

IV. Provider business mailing address

233 W. BASELINE RD BOX 400
LA VERNE CA
91750-1854
US

V. Phone/Fax

Practice location:
  • Phone: 909-833-2986
  • Fax: 909-833-2998
Mailing address:
  • Phone: 626-673-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF 96499
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: