Healthcare Provider Details

I. General information

NPI: 1295422905
Provider Name (Legal Business Name): IVON DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 NW 173RD DR UNIT 10
HIALEAH FL
33015-5107
US

IV. Provider business mailing address

14321 LAKE CRESCENT PL
MIAMI LAKES FL
33014-3034
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-7884
  • Fax:
Mailing address:
  • Phone: 786-426-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: