Provider Demographics
NPI:1821292202
Name:DELGADO, ALICIA (RAS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RAS
Mailing Address - Street 1:2101 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4521
Mailing Address - Country:US
Mailing Address - Phone:800-996-1051
Mailing Address - Fax:310-217-0545
Practice Address - Street 1:2101 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4521
Practice Address - Country:US
Practice Address - Phone:800-996-1051
Practice Address - Fax:310-217-0545
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAC052160418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)