Provider Demographics
NPI:1801954649
Name:DELGADO, RONALD FELICIANO
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FELICIANO
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 1:266 S MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5711
Mailing Address - Country:US
Mailing Address - Phone:813-655-4700
Mailing Address - Fax:
Practice Address - Street 1:16942 DORMAN RD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-1722
Practice Address - Country:US
Practice Address - Phone:813-362-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271808100Medicaid
FLH39903Medicare UPIN