Provider Demographics
NPI:1104378785
Name:DELGADO, MARISSSA (CSM)
Entity Type:Individual
Prefix:
First Name:MARISSSA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:CSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11118 POUNDS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-3231
Mailing Address - Country:US
Mailing Address - Phone:213-663-2721
Mailing Address - Fax:562-777-2237
Practice Address - Street 1:11118 POUNDS AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-3231
Practice Address - Country:US
Practice Address - Phone:213-663-2721
Practice Address - Fax:562-777-2237
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194700186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health