Provider Demographics
NPI:1427412451
Name:DELIGERO, PATRICK HACHERO (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:HACHERO
Last Name:DELIGERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-977-4639
Mailing Address - Fax:562-471-4479
Practice Address - Street 1:9209 COLIMA RD STE 1000
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1813
Practice Address - Country:US
Practice Address - Phone:562-696-1104
Practice Address - Fax:562-696-2885
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPD3232267556Medicaid