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General NPI Number Information
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NPI Number | 1548738198
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Entity Type | Individual
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Provider Name | JONATHAN DELGADO-LOPEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 2702 LOW CT
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City | FAIRFIELD
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State | CA
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Zip | 94534-9771
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Country | US
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Telephone | 707-432-2777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55983
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License Number State | CA
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