Healthcare Provider Details

I. General information

NPI: 1053534065
Provider Name (Legal Business Name): MRS. ILEANA DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CRISTOBAL COLON #54
YABUCOA PR
00767-0745
US

IV. Provider business mailing address

PO BOX 745
YABUCOA PR
00767-0745
US

V. Phone/Fax

Practice location:
  • Phone: 787-893-0975
  • Fax: 787-893-3984
Mailing address:
  • Phone: 787-893-0975
  • Fax: 787-893-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5584
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: