MEDICARE: MANUEL 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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1131	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1437268562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL DELGADO

Provider Business Mailing Address
First Line	:	920 STABLE GLEN DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1830
Country	:	US
Telephone Number	:	702-446-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	STE 300
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-642-0441
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ MANUEL DELGADO ” Practice Location

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