Provider Demographics
NPI:1689378705
Name:DELGADO RODRIGUEZ, WANDA EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:EVELYN
Last Name:DELGADO RODRIGUEZ
Suffix:
Gender:F
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:HC 3 BOX 12704
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-7359
Mailing Address - Country:US
Mailing Address - Phone:787-400-0150
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 96.5 INTERIOR LOTE 5 BO YEGUADA
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-7359
Practice Address - Country:US
Practice Address - Phone:787-400-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR802-PA363AM0700X
PR23320208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical