Provider Demographics
NPI:1740524925
Name:DELGADO, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SW 1ST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1601
Mailing Address - Country:US
Mailing Address - Phone:305-631-8931
Mailing Address - Fax:305-631-0546
Practice Address - Street 1:1901 SW 1ST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1601
Practice Address - Country:US
Practice Address - Phone:305-631-8931
Practice Address - Fax:305-631-0546
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002485400Medicaid