Provider Demographics
NPI:1346654712
Name:DELGADO MEDICAL MASSAGE
Entity Type:Organization
Organization Name:DELGADO MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE THERPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-571-3629
Mailing Address - Street 1:1150 W HARTLEY AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-9773
Mailing Address - Country:US
Mailing Address - Phone:571-541-3629
Mailing Address - Fax:
Practice Address - Street 1:1150 W HARTLEY AVE
Practice Address - Street 2:SUITE J
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-9773
Practice Address - Country:US
Practice Address - Phone:571-541-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty