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General NPI Number Information
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NPI Number | 1861210668
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Entity Type | Individual
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Provider Name | JORGE MANUEL DELGADO JR. RDH
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1655 N MOUNT VERNON AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1427
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Country | US
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Telephone | 909-361-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 951 CLOVER ST
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City | SAN JACINTO
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State | CA
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Zip | 92582-3888
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Country | US
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Telephone | 909-953-1225
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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