Healthcare Provider Details

I. General information

NPI: 1255756540
Provider Name (Legal Business Name): LUCIA DELGADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 MIRAVISTA PL SE
ALBUQUERQUE NM
87123-5996
US

IV. Provider business mailing address

11124 MIRAVISTA PL SE
ALBUQUERQUE NM
87123-5996
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-3460
  • Fax:
Mailing address:
  • Phone: 505-620-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH3173
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNM-88051
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN88051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: