Healthcare Provider Details

I. General information

NPI: 1871832410
Provider Name (Legal Business Name): VANESSA RENEE DELGADILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 5TH ST STE D
MOORE OK
73160-3947
US

IV. Provider business mailing address

317 SE 67TH ST
OKLAHOMA CITY OK
73149-1407
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-4469
  • Fax:
Mailing address:
  • Phone: 405-476-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: