Provider Demographics
NPI:1881000487
Name:DELGADO, LIZETH REBECA (OD)
Entity type:Individual
Prefix:DR
First Name:LIZETH
Middle Name:REBECA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 NEWTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4570
Mailing Address - Country:US
Mailing Address - Phone:786-200-6722
Mailing Address - Fax:
Practice Address - Street 1:1500 E MERRITT ISLAND CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2612
Practice Address - Country:US
Practice Address - Phone:321-449-1045
Practice Address - Fax:321-449-8568
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5267152W00000X
WAOD60484468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018420300Medicaid
FLIR458AMedicare PIN