Provider Demographics
NPI:1063249464
Name:DELGADO, ALEXANDER HERNAN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HERNAN
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 1:1500 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-7448
Mailing Address - Country:US
Mailing Address - Phone:909-257-4791
Mailing Address - Fax:
Practice Address - Street 1:1500 W 18TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-7448
Practice Address - Country:US
Practice Address - Phone:909-257-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker