Healthcare Provider Details

I. General information

NPI: 1023530854
Provider Name (Legal Business Name): JORGE ARTURO DELGADILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6685
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6000
  • Fax:
Mailing address:
  • Phone: 801-374-9625
  • Fax: 801-374-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number7982782-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: