MEDICARE: GERARDO DELGADO CSA

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	363AS0400X	Surgical Physician Assistant	23-418	TX

General Provider Information

NPI Number	:	1679361422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO DELGADO CSA

Provider Business Mailing Address
First Line	:	18325 KINGSLAND BLVD APT 1329
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77094-1528
Country	:	US
Telephone Number	:	281-896-6032
Fax Number	:

Provider Business Practice Location Address
First Line	:	14403 WALTERS RD # 680366
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1336
Country	:	US
Telephone Number	:	713-254-6136
Fax Number	:

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

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	06/26/2025

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