Healthcare Provider Details

I. General information

NPI: 1801674338
Provider Name (Legal Business Name): MABEL LINAIRIS PEREGRIN DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22901 MILLCREEK BLVD STE 200
BEACHWOOD OH
44122-5701
US

IV. Provider business mailing address

45 ERIEVIEW PLZ APT 1123
CLEVELAND OH
44114-1904
US

V. Phone/Fax

Practice location:
  • Phone: 786-290-8195
  • Fax: 786-866-2801
Mailing address:
  • Phone: 786-290-8195
  • Fax: 786-866-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES004909
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: