Provider Demographics
NPI:1063854883
Name:DELGADO MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:DELGADO MEDICAL GROUP LLC
Other - Org Name:NEW LIFE SPINE AND JOINT PASADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:281-487-3999
Mailing Address - Street 1:3910 FAIRMONT PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3076
Mailing Address - Country:US
Mailing Address - Phone:281-487-3999
Mailing Address - Fax:281-487-7433
Practice Address - Street 1:3910 FAIRMONT PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3076
Practice Address - Country:US
Practice Address - Phone:281-487-3999
Practice Address - Fax:281-487-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty