Provider Demographics
NPI:1235355942
Name:DELGADO, PHILIP ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANTHONY
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 GROVE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3140
Mailing Address - Country:US
Mailing Address - Phone:909-527-4909
Mailing Address - Fax:909-360-0128
Practice Address - Street 1:8283 GROVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-527-4909
Practice Address - Fax:909-360-0128
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083641OtherMEDICAL
CAGR0083640Medicaid
CAGR0083641OtherMEDICAL