Provider Demographics
NPI:1659543619
Name:DELGADO, YANSSEL (DPM)
Entity Type:Individual
Prefix:
First Name:YANSSEL
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1964
Mailing Address - Country:US
Mailing Address - Phone:305-819-9240
Mailing Address - Fax:305-819-8241
Practice Address - Street 1:630 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1964
Practice Address - Country:US
Practice Address - Phone:305-819-9240
Practice Address - Fax:305-819-8241
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3347213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000163500Medicaid
FL65109OtherBCBS
FLAV336ZMedicare PIN