Provider Demographics
NPI:1639430523
Name:DELGADO, JOSE ALFONSO JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALFONSO
Last Name:DELGADO
Suffix:JR
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 1:12014 WIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-5459
Mailing Address - Country:US
Mailing Address - Phone:818-489-8576
Mailing Address - Fax:
Practice Address - Street 1:12014 WIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-5459
Practice Address - Country:US
Practice Address - Phone:818-489-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist