Provider Demographics
NPI:1376578591
Name:DELGADO, MIGUEL ANGEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:DELGADO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ROWLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5038
Mailing Address - Country:US
Mailing Address - Phone:415-898-4161
Mailing Address - Fax:415-897-4664
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-898-4161
Practice Address - Fax:415-897-4664
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE48485Medicare UPIN