Provider Demographics
NPI:1356987622
Name:DELGADO, IVETTE
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CIUDAD JARDIN III
Mailing Address - Street 2:492 CALLE ALCANFOR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4893
Mailing Address - Country:US
Mailing Address - Phone:787-565-2970
Mailing Address - Fax:
Practice Address - Street 1:URB CIUDAD JARDIN III
Practice Address - Street 2:492 CALLE ALCANFOR
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00949-4893
Practice Address - Country:US
Practice Address - Phone:787-565-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist