Provider Demographics
NPI:1639514441
Name:DELGADO, ISAMAR ERMESE (LMFT 111868)
Entity Type:Individual
Prefix:
First Name:ISAMAR
Middle Name:ERMESE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LMFT 111868
Other - Prefix:
Other - First Name:ISAMAR
Other - Middle Name:ERMESE
Other - Last Name:BAEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT 111868
Mailing Address - Street 1:7572 CIRCUIT DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-4446
Mailing Address - Country:US
Mailing Address - Phone:831-840-5116
Mailing Address - Fax:
Practice Address - Street 1:770 L ST STE 950
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3361
Practice Address - Country:US
Practice Address - Phone:916-572-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91709106H00000X
CA111868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#