Provider Demographics
NPI:1528337920
Name:DELGADILLO, JORGE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:DELGADILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:DELGADILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3939 ATLANTIC AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3536
Mailing Address - Country:US
Mailing Address - Phone:562-457-6010
Mailing Address - Fax:562-424-5600
Practice Address - Street 1:3939 ATLANTIC AVE
Practice Address - Street 2:STE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3536
Practice Address - Country:US
Practice Address - Phone:562-457-6010
Practice Address - Fax:562-424-5600
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA032214208D00000X
MI33524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204691Medicare PIN