Provider Demographics
NPI:1497294268
Name:DELGADO, RAICEL ARIEL
Entity Type:Individual
Prefix:MR
First Name:RAICEL
Middle Name:ARIEL
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 W FLAGLER ST APT 312
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2042
Mailing Address - Country:US
Mailing Address - Phone:786-226-6297
Mailing Address - Fax:
Practice Address - Street 1:1665 W 68TH ST STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4400
Practice Address - Country:US
Practice Address - Phone:786-773-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst