Provider Demographics
NPI:1255620712
Name:DELGADO, MARIA LOURDES (RDH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:DELGADO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S OCHOA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2936
Mailing Address - Country:US
Mailing Address - Phone:915-545-7082
Mailing Address - Fax:915-533-4878
Practice Address - Street 1:1313 SAN ANTONIO STREET
Practice Address - Street 2:
Practice Address - City:SAN ELIZARIO
Practice Address - State:TX
Practice Address - Zip Code:79849-1030
Practice Address - Country:US
Practice Address - Phone:915-851-3157
Practice Address - Fax:915-851-0558
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist