MEDICARE: GUSTAVO JOEL DELGADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1083494819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO JOEL DELGADO

Provider Business Mailing Address
First Line	:	32709 VIEW HAVEN LN
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-7711
Country	:	US
Telephone Number	:	787-344-7369
Fax Number	:

Provider Business Practice Location Address
First Line	:	32709 VIEW HAVEN LN
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-7711
Country	:	US
Telephone Number	:	787-344-7369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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