Provider Demographics
NPI:1770642597
Name:DELGADO, DIANA MARIBEL (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIBEL
Last Name:DELGADO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:386-673-2770
Mailing Address - Fax:386-673-2760
Practice Address - Street 1:725 W GRANADA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9406
Practice Address - Country:US
Practice Address - Phone:386-673-2770
Practice Address - Fax:386-673-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265766000Medicaid