Provider Demographics
NPI:1255642633
Name:DELGADO, MIGUEL (OD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 TELEGRAPH RD
Mailing Address - Street 2:#2505
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4328
Mailing Address - Country:US
Mailing Address - Phone:805-643-5687
Mailing Address - Fax:805-643-4175
Practice Address - Street 1:24 S CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2802
Practice Address - Country:US
Practice Address - Phone:805-643-5687
Practice Address - Fax:805-643-4175
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL974AMedicare PIN