Provider Demographics
NPI:1124791835
Name:DELGADO, VANESSA LIZETTE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LIZETTE
Last Name:DELGADO
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 1:16804 WINDCREST DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0889
Mailing Address - Country:US
Mailing Address - Phone:909-904-0140
Mailing Address - Fax:
Practice Address - Street 1:16804 WINDCREST DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-0889
Practice Address - Country:US
Practice Address - Phone:909-904-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty