Provider Demographics
NPI:1861473845
Name:DELGADO, LETICIA (PA)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:446-300-7008
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:10435 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7920
Practice Address - Country:US
Practice Address - Phone:915-217-2117
Practice Address - Fax:915-217-1105
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-02753363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C7451Medicare ID - Type Unspecified
TXQ28022Medicare UPIN