Healthcare Provider Details

I. General information

NPI: 1801334792
Provider Name (Legal Business Name): JEFFREY A DELGADILLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 K ST STE 101
SACRAMENTO CA
95816-5114
US

IV. Provider business mailing address

2525 K ST STE 101
SACRAMENTO CA
95816-5114
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-1882
  • Fax:
Mailing address:
  • Phone: 916-442-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS107240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: