Provider Demographics
NPI:1821376781
Name:DELGADILLO, ARMIDA GOMEZ (RBT)
Entity Type:Individual
Prefix:MS
First Name:ARMIDA
Middle Name:GOMEZ
Last Name:DELGADILLO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:ARMIDA
Other - Middle Name:RODRIGUEZ
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8030 LA MESA BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0335
Mailing Address - Country:US
Mailing Address - Phone:619-782-0700
Mailing Address - Fax:619-782-0710
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3763
Practice Address - Country:US
Practice Address - Phone:619-782-0700
Practice Address - Fax:619-782-0710
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CARBT-17-37662106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT-17-37662OtherBACB
CA1821376781Medicaid