Provider Demographics
NPI:1619247178
Name:DELGADO, RAQUEL R (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:R
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 AUSTIN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-4548
Mailing Address - Country:US
Mailing Address - Phone:325-998-6768
Mailing Address - Fax:
Practice Address - Street 1:2200 AUSTIN AVE
Practice Address - Street 2:STE B
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-4548
Practice Address - Country:US
Practice Address - Phone:325-998-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist