Provider Demographics
NPI:1134852551
Name:DELGADO, MICHELLE (PROPIETOR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PROPIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CALLE BRAVIA
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2592
Mailing Address - Country:US
Mailing Address - Phone:787-246-0330
Mailing Address - Fax:
Practice Address - Street 1:433 AVE GENERAL VALERO
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3943
Practice Address - Country:US
Practice Address - Phone:787-246-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies