Provider Demographics
NPI:1922065218
Name:DELGADO, CARLOS LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:LORENZO
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:1957 WEST 60 STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-825-8170
Mailing Address - Fax:305-825-8177
Practice Address - Street 1:1957 WEST 60 STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-825-8170
Practice Address - Fax:305-825-8177
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65801208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374846400Medicaid
F77240Medicare UPIN
FL23976YMedicare PIN