Provider Demographics
NPI:1760416044
Name:DELGADO, MAYRA MANUELA (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:MANUELA
Last Name:DELGADO
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 1:1000 PARK CENTRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5373
Mailing Address - Country:US
Mailing Address - Phone:305-621-0023
Mailing Address - Fax:305-623-9188
Practice Address - Street 1:1000 PARK CENTRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5373
Practice Address - Country:US
Practice Address - Phone:305-621-0023
Practice Address - Fax:305-623-9188
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372817000Medicaid
FL372817000Medicaid
FL09526ZMedicare PIN