Healthcare Provider Details

I. General information

NPI: 1316857840
Provider Name (Legal Business Name): JOSE DANIEL ANDY DELGADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 MURPHY CANYON RD
SAN DIEGO CA
92123-4410
US

IV. Provider business mailing address

26428 FIELD ST
MORENO VALLEY CA
92555-2550
US

V. Phone/Fax

Practice location:
  • Phone: 951-525-6296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number757097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: