Healthcare Provider Details

I. General information

NPI: 1063424950
Provider Name (Legal Business Name): ANITA V. DELGADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MASTHEAD ST NE SUITE 120
ALBUQUERQUE NM
87109-4327
US

IV. Provider business mailing address

1720 LOUISIANA BLVD NE STE 401
ALBUQUERQUE NM
87110-7020
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-7729
  • Fax: 505-243-4804
Mailing address:
  • Phone: 505-260-4323
  • Fax: 505-243-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2004-0231
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: