Healthcare Provider Details

I. General information

NPI: 1992795975
Provider Name (Legal Business Name): ADA L DELGADO MATEO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLZ SUITE 902
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

BAYAMON MEDICAL PLZ SUITE 902
BAYAMON PR
00959-7200
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9212
  • Fax: 787-785-9212
Mailing address:
  • Phone: 787-780-9212
  • Fax: 787-785-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11110
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: