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General NPI Number Information
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NPI Number | 1639522964
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Entity Type | Individual
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Provider Name | DERRICK DELGADO PTA
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Gender | Male
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 5312 RIO BRAVO DR STE 7
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City | SANTA TERESA
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State | NM
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Zip | 88008-9210
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Country | US
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Telephone | 575-201-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 COYOTE LN
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City | EL PASO
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State | TX
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Zip | 79912-7490
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Country | US
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Telephone | 915-252-0596
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA1723
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTA1723
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License Number State | NM
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