Provider Demographics
NPI:1457361685
Name:DELGADO, JUAN LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
Last Name:DELGADO
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 1:25701 ARUNDEL WAY
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9570
Mailing Address - Country:US
Mailing Address - Phone:352-383-8166
Mailing Address - Fax:
Practice Address - Street 1:9580 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6947
Practice Address - Country:US
Practice Address - Phone:407-296-9096
Practice Address - Fax:407-296-8023
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 37814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE14931Medicare UPIN