MEDICARE: MAGNOLIA 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	103K00000X	Behavior Analyst	1-24-73455	CA

General Provider Information

NPI Number	:	1114760071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGNOLIA DELGADO

Provider Business Mailing Address
First Line	:	1210 S WASHINGTON AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-4655
Country	:	US
Telephone Number	:	424-278-5706
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 E ANAHEIM RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4329
Country	:	US
Telephone Number	:	562-453-9760
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	11/18/2024

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