Healthcare Provider Details

I. General information

NPI: 1700996923
Provider Name (Legal Business Name): GEORGE DELGADO M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA STE. 106
SAN DIEGO CA
92108-3116
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA STE. 106
SAN DIEGO CA
92108-3116
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-4401
  • Fax: 619-692-8147
Mailing address:
  • Phone: 619-692-4401
  • Fax: 619-692-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG66807
License Number StateCA

VIII. Authorized Official

Name: MR. JOSEPH R ANDERSON
Title or Position: MEDICAL PRACTICE MANAGER
Credential:
Phone: 619-692-4401