Provider Demographics
NPI:1508997222
Name:DELGADILLO, JACQUELINE (LAC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DELGADILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2407
Mailing Address - Country:US
Mailing Address - Phone:718-297-6391
Mailing Address - Fax:718-297-6391
Practice Address - Street 1:15105 85TH DR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2509
Practice Address - Country:US
Practice Address - Phone:718-297-6391
Practice Address - Fax:718-297-6391
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist