Provider Demographics
NPI:1609826338
Name:DELGADO, JULIAN L (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:L
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 17TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:530-458-8050
Mailing Address - Fax:530-458-5936
Practice Address - Street 1:2967 DAVISON CT.
Practice Address - Street 2:SUITE A
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-3263
Practice Address - Country:US
Practice Address - Phone:530-458-8050
Practice Address - Fax:530-458-5936
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG55334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20967ZMedicare ID - Type Unspecified
CAE58401Medicare UPIN