Healthcare Provider Details

I. General information

NPI: 1003429960
Provider Name (Legal Business Name): VICTOR RAFAEL DELGADO LAZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FIRST AVENUE METROPOLITAN HOSPITAL CENTER, DEPARTMENT OF MEDICINE
NEW YORK NY
10029
US

IV. Provider business mailing address

1901 FIRST AVENUE METROPOLITAN HOSPITAL CENTER, DEPARTMENT OF MEDICINE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax:
Mailing address:
  • Phone: 212-423-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: