Healthcare Provider Details

I. General information

NPI: 1083639470
Provider Name (Legal Business Name): GEORGE DELGADO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA STE 106
SAN DIEGO CA
92108-3117
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA STE 106
SAN DIEGO CA
92108-3117
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 Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG66807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: