Healthcare Provider Details

I. General information

NPI: 1366787772
Provider Name (Legal Business Name): AMANDA NICOLE DELGADO HEERBOTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NICOLE DELGADO

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

IV. Provider business mailing address

2527 LANSFORD AVE
SAN JOSE CA
95125-4057
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-2280
  • Fax: 408-754-0450
Mailing address:
  • Phone: 408-666-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number779153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: