Provider Demographics
NPI:1265432041
Name:DELAGANDARA, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:DELAGANDARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 PALM BEACH LAKES BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6607
Mailing Address - Country:US
Mailing Address - Phone:561-687-2111
Mailing Address - Fax:561-687-1777
Practice Address - Street 1:2161 PALM BEACH LAKES BLVD
Practice Address - Street 2:STE 215
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6607
Practice Address - Country:US
Practice Address - Phone:561-687-2111
Practice Address - Fax:561-687-1777
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD84894Medicare UPIN
FLFL05721Medicare ID - Type Unspecified