Provider Demographics
NPI:1720310758
Name:DELGADO, IRIS NEREIDA (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:NEREIDA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 801
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JOSE DE DIEGO STREET #90
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00739
Practice Address - Country:UM
Practice Address - Phone:787-636-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4444Medicaid
4421OtherAPS, FHCHS
PR4949Medicare PIN
PR4444Medicaid