Provider Demographics
NPI:1528594504
Name:ANTIGUA, DELILAH
Entity Type:Individual
Prefix:
First Name:DELILAH
Middle Name:
Last Name:ANTIGUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 S MANCHESTER AVE
Mailing Address - Street 2:STE. 108
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3800
Mailing Address - Country:US
Mailing Address - Phone:714-588-2619
Mailing Address - Fax:
Practice Address - Street 1:1835 S MANCHESTER AVE
Practice Address - Street 2:STE. 108
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3800
Practice Address - Country:US
Practice Address - Phone:714-588-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3747594253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care