1174521447 NPI number — DR. MARTA I DELGADO MD

Table of content: DR. MARTA I DELGADO MD (NPI 1174521447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174521447 NPI number — DR. MARTA I DELGADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO
Provider First Name:
MARTA
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174521447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 NE 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-243-1909
Provider Business Mailing Address Fax Number:
786-243-4292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 NE 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-243-1909
Provider Business Practice Location Address Fax Number:
786-243-4292
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  ME86719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME86719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 268437301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5598641 . This is a "FIRST HEALTH ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 157747195334 . This is a "HUMANA PROVIDER ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 285747 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7988633 . This is a "AETNA PROVIDER ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 268437300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274606 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 64062 . This is a "BCB PROVIDER ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 296148 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024915100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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