Provider Demographics
NPI:1255803839
Name:DELGADO, GEORGI-IILEEN PATRICIA
Entity type:Individual
Prefix:
First Name:GEORGI-IILEEN
Middle Name:PATRICIA
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-202 LAHUI PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4279
Mailing Address - Country:US
Mailing Address - Phone:570-556-9682
Mailing Address - Fax:
Practice Address - Street 1:95-202 LAHUI PL
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4279
Practice Address - Country:US
Practice Address - Phone:570-556-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-18-73417106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician