Healthcare Provider Details

I. General information

NPI: 1437669074
Provider Name (Legal Business Name): ADRIAN ALEXANDER DELGADO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 CALLE DEL NORTE STE 440
LAREDO TX
78041-6040
US

IV. Provider business mailing address

1505 CALLE DEL NORTE STE 440
LAREDO TX
78041-6040
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-6221
  • Fax: 956-722-6275
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2132215
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: