Provider Demographics
NPI:1538900782
Name:DELGADO, LUDIVINA (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MISS
First Name:LUDIVINA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:MISS
Other - First Name:LUDIVINA
Other - Middle Name:
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED OPTICIAN
Mailing Address - Street 1:HC 2 BOX 4636
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-7512
Mailing Address - Country:US
Mailing Address - Phone:939-441-0052
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 4636
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-7512
Practice Address - Country:US
Practice Address - Phone:939-441-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR765156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician