Provider Demographics
NPI:1104878727
Name:DELGADO, JAIME H (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:H
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5333
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-5333
Mailing Address - Country:US
Mailing Address - Phone:310-329-2469
Mailing Address - Fax:310-329-0176
Practice Address - Street 1:1025 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5806
Practice Address - Country:US
Practice Address - Phone:310-329-2469
Practice Address - Fax:310-329-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA244112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A244110Medicaid
CATP0116Medicare PIN