Provider Demographics
NPI:1558113829
Name:DELGADO, PARK FRASER
Entity Type:Individual
Prefix:
First Name:PARK
Middle Name:FRASER
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 1:33 NW 118TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-4428
Mailing Address - Country:US
Mailing Address - Phone:786-493-8756
Mailing Address - Fax:
Practice Address - Street 1:12040 S JOG RD STE 8
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:561-733-5083
Practice Address - Fax:561-733-5084
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24992225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist