Provider Demographics
NPI:1720040322
Name:DELGADO, MIRTA C (DO)
Entity Type:Individual
Prefix:DR
First Name:MIRTA
Middle Name:C
Last Name:DELGADO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2977
Mailing Address - Country:US
Mailing Address - Phone:650-261-3710
Mailing Address - Fax:
Practice Address - Street 1:630 LAUREL ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2977
Practice Address - Country:US
Practice Address - Phone:650-261-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222257208000000X
CA20A 10417208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH89174Medicare UPIN