Provider Demographics
NPI:1093082059
Name:DELGADO, MARTHA (MA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8343 SW 162ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5125
Mailing Address - Country:US
Mailing Address - Phone:786-262-9169
Mailing Address - Fax:305-380-0615
Practice Address - Street 1:7911 NW 72ND AVE
Practice Address - Street 2:119 B
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2227
Practice Address - Country:US
Practice Address - Phone:786-262-9169
Practice Address - Fax:305-885-5180
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist