Provider Demographics
NPI:1356579544
Name:DELGADO, WANDALIZ (LOTA)
Entity type:Individual
Prefix:MS
First Name:WANDALIZ
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 4 G-6 URB. LOS TAMARINDOS
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-3723
Mailing Address - Country:US
Mailing Address - Phone:787-362-2412
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS TAMARINDOS CALLE G-6 CALLE 4
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-3723
Practice Address - Country:US
Practice Address - Phone:787-715-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR780224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant