=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336936319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER VILLARRAGA DELGADO NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2526 SISTER MARY COLUMBA DR
-----------------------------------------------------
City | RED BLUFF
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96080-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-690-2778
-----------------------------------------------------
Fax | 978-416-8198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 908
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96021-0908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-690-2827
-----------------------------------------------------
Fax | 978-416-8198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95031239
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------