Provider Demographics
NPI:1083017990
Name:DELGRA, LUCELO
Entity Type:Individual
Prefix:
First Name:LUCELO
Middle Name:
Last Name:DELGRA
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 1:4141 N HENDERSON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2486
Mailing Address - Country:US
Mailing Address - Phone:704-258-1282
Mailing Address - Fax:703-276-3339
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:704-258-1282
Practice Address - Fax:703-276-3339
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist