Provider Demographics
NPI:1932839750
Name:DELGADILLO, EPHRAIM ALEJANDRO JR (CADC-I)
Entity Type:Individual
Prefix:MR
First Name:EPHRAIM
Middle Name:ALEJANDRO
Last Name:DELGADILLO
Suffix:JR
Gender:M
Credentials:CADC-I
Other - Prefix:
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Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9506
Mailing Address - Country:US
Mailing Address - Phone:209-352-6632
Mailing Address - Fax:209-206-4163
Practice Address - Street 1:18670 CARTER ST.
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9537
Practice Address - Country:US
Practice Address - Phone:209-352-6632
Practice Address - Fax:209-206-4163
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CACI32200321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)