Provider Demographics
NPI:1356969547
Name:DELGADO, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
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 1:12800 SW 43RD DR APT 210B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4149
Mailing Address - Country:US
Mailing Address - Phone:786-316-3418
Mailing Address - Fax:
Practice Address - Street 1:12800 SW 43RD DR APT 210B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4149
Practice Address - Country:US
Practice Address - Phone:786-316-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician