Healthcare Provider Details

I. General information

NPI: 1992734602
Provider Name (Legal Business Name): JOEL S DELGADO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 WESTCHESTER CIR
STOCKTON CA
95219-7168
US

IV. Provider business mailing address

5726 WESTCHESTER CIR
STOCKTON CA
95219-7168
US

V. Phone/Fax

Practice location:
  • Phone: 209-401-8540
  • Fax: 209-951-2521
Mailing address:
  • Phone: 209-401-8540
  • Fax: 209-951-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01013600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 33127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: