Provider Demographics
NPI:1043532674
Name:DELGADO, LUISINIA ALICIA (DDS)
Entity Type:Individual
Prefix:
First Name:LUISINIA
Middle Name:ALICIA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BAY AREA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1404
Mailing Address - Country:US
Mailing Address - Phone:281-560-4543
Mailing Address - Fax:
Practice Address - Street 1:1000 BAY AREA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1404
Practice Address - Country:US
Practice Address - Phone:281-560-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59109122300000X
TX344561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist