Healthcare Provider Details

I. General information

NPI: 1528190162
Provider Name (Legal Business Name): NORA ELENA DELGADO-VELASQUEZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W KENNEDY BLVD SUITE 202
TAMPA FL
33609-2976
US

IV. Provider business mailing address

13805 SPRINGER LN
TAMPA FL
33625-4143
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-2969
  • Fax:
Mailing address:
  • Phone: 813-383-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN0012536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: