Provider Demographics
NPI:1194500256
Name:DE LA CANTERA DELGADO, ANGEL GABRIEL
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:GABRIEL
Last Name:DE LA CANTERA 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 1:13479 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7176
Mailing Address - Country:US
Mailing Address - Phone:305-763-3658
Mailing Address - Fax:
Practice Address - Street 1:1031 IVES DAIRY RD STE 240
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2521
Practice Address - Country:US
Practice Address - Phone:954-865-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician