Healthcare Provider Details

I. General information

NPI: 1639713746
Provider Name (Legal Business Name): BRANDO BRYAN DELGADO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WALNUT AVE STE 26
SAN DIEGO CA
92103-4980
US

IV. Provider business mailing address

306 WALNUT AVE STE 26
SAN DIEGO CA
92103-4980
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberA204372
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11176
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: