Provider Demographics
NPI:1306922455
Name:CONCEPCION DELGADO, JOSE ANTONIO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:CONCEPCION 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:URB. FLORAL PARK CALLE ESPANA 523
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-641-0774
Mailing Address - Fax:787-641-0776
Practice Address - Street 1:URB. FLORAL PARK CALLE ESPANA 523
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:787-641-0776
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical