=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639637002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELGADO MEDICAL SERV CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2019
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15251 SW 56TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-760-5826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 960244
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33296-0244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-760-5826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MISS SANDRA MONICA DELGADO
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 786-760-5826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------