Provider Demographics
NPI:1164004263
Name:DELGADO, ENEDINA L
Entity Type:Individual
Prefix:
First Name:ENEDINA
Middle Name:L
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 STATE ROUTE 7 S
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8919
Mailing Address - Country:US
Mailing Address - Phone:740-208-0619
Mailing Address - Fax:
Practice Address - Street 1:10130 STATE ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8919
Practice Address - Country:US
Practice Address - Phone:740-208-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224481Medicaid