Healthcare Provider Details

I. General information

NPI: 1689713216
Provider Name (Legal Business Name): JONATHAN MARK DELGADO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W F ST
ONTARIO CA
91762-3201
US

IV. Provider business mailing address

200 CITADEL DR
COMMERCE CA
90040-1523
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-4550
  • Fax:
Mailing address:
  • Phone: 323-838-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23435
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: