Provider Demographics
NPI:1699565309
Name:DELGADO, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:DELGADO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2855
Mailing Address - Country:US
Mailing Address - Phone:719-320-3658
Mailing Address - Fax:
Practice Address - Street 1:3430 PECAN DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2855
Practice Address - Country:US
Practice Address - Phone:719-320-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities