Provider Demographics
NPI:1851862189
Name:DELGADO, JOSEPHINE KARINA
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:KARINA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1941
Mailing Address - Country:US
Mailing Address - Phone:970-208-2643
Mailing Address - Fax:
Practice Address - Street 1:741 W WILSHIRE CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1826
Practice Address - Country:US
Practice Address - Phone:970-245-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO03-100-0296171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83-2790442OtherHOMEAID