Provider Demographics
NPI:1790446615
Name:DELGADO, VIVIAN MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MARIE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:MARIE
Other - Last Name:ARROYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6119 D AND J DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3264
Mailing Address - Country:US
Mailing Address - Phone:813-240-7935
Mailing Address - Fax:
Practice Address - Street 1:6119 D AND J DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3264
Practice Address - Country:US
Practice Address - Phone:813-240-7935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH9101124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist