Provider Demographics
NPI:1275924920
Name:DELGADO, IVAN (ATC)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NE 62ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5116
Mailing Address - Country:US
Mailing Address - Phone:954-776-2124
Mailing Address - Fax:954-492-4562
Practice Address - Street 1:1501 NE 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-5116
Practice Address - Country:US
Practice Address - Phone:954-776-2124
Practice Address - Fax:954-492-4562
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL34832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer