Provider Demographics
NPI:1124734348
Name:DELAGARZA, DELTA CAMILLE
Entity type:Individual
Prefix:
First Name:DELTA
Middle Name:CAMILLE
Last Name:DELAGARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6038
Mailing Address - Country:US
Mailing Address - Phone:361-894-4493
Mailing Address - Fax:
Practice Address - Street 1:107 THIS WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5213
Practice Address - Country:US
Practice Address - Phone:361-894-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor