Healthcare Provider Details

I. General information

NPI: 1427720754
Provider Name (Legal Business Name): MARCOS ELIUD NATAL DELIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CARR 2 # KM
MANATI PR
00674-4894
US

IV. Provider business mailing address

169 CALLE SIRENA
HATILLO PR
00659-2769
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-2292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22843
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier22843
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: