Provider Demographics
NPI:1619726676
Name:DELGADO, LUIS ANGEL
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANGEL
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 132 KM 22.1 BO CANAS
Mailing Address - Street 2:PLAZA GABRIELA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-672-3357
Mailing Address - Fax:787-812-3931
Practice Address - Street 1:CARR 132 KM 22.1 BO CANAS
Practice Address - Street 2:PLAZA GABRIELA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-672-3357
Practice Address - Fax:787-812-3931
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23762208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty