Provider Demographics
NPI:1245528678
Name:DELGADO, YAZMIN (LMT)
Entity type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 ENTRANCE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-6923
Mailing Address - Country:US
Mailing Address - Phone:813-873-1361
Mailing Address - Fax:813-873-1325
Practice Address - Street 1:2123 W MARTIN LUTHER KING JR BOULEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-873-1361
Practice Address - Fax:813-873-1325
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist