Healthcare Provider Details

I. General information

NPI: 1528731676
Provider Name (Legal Business Name): CRYSTAL M DOLAN DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W SANGER ST
HOBBS NM
88240-4917
US

IV. Provider business mailing address

921 W SANGER ST
HOBBS NM
88240-4917
US

V. Phone/Fax

Practice location:
  • Phone: 575-433-2002
  • Fax: 888-729-4956
Mailing address:
  • Phone: 575-433-2002
  • Fax: 888-729-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: