Provider Demographics
NPI:1225675267
Name:VIRATA-DELGADO, AGNES CALLAO (RN)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:CALLAO
Last Name:VIRATA-DELGADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 NORTH SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1211
Mailing Address - Country:US
Mailing Address - Phone:773-905-3139
Mailing Address - Fax:
Practice Address - Street 1:4321 NORTH SAWYER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1211
Practice Address - Country:US
Practice Address - Phone:773-905-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770976163WP2201X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care