Provider Demographics
NPI:1770076283
Name:DELGADO FUENTES, ALAIN
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:DELGADO FUENTES
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 1:3515 SE 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5588
Mailing Address - Country:US
Mailing Address - Phone:352-509-9165
Mailing Address - Fax:
Practice Address - Street 1:3515 SE 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5588
Practice Address - Country:US
Practice Address - Phone:352-509-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME147662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111040500Medicaid