Provider Demographics
NPI:1578711537
Name:DELGADO, GARY
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4590 COVE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8954
Mailing Address - Country:US
Mailing Address - Phone:951-306-2837
Mailing Address - Fax:
Practice Address - Street 1:14700 MANZANITA RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3026
Practice Address - Country:US
Practice Address - Phone:951-845-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty