=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124932447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MARLEN DELGADO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45180 CLUB DR
-----------------------------------------------------
City | INDIAN WELLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92210-8806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-354-8285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82906 VIA MILANO
-----------------------------------------------------
City | INDIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92201-6948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | Y9758072
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------