Provider Demographics
NPI:1962788448
Name:DELGADO, LYNETTE
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
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 1:277 CALLE SAN LUCAS
Mailing Address - Street 2:URB VALLE SAN LUIS
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-390-0062
Mailing Address - Fax:
Practice Address - Street 1:277 CALLE SAN LUCAS
Practice Address - Street 2:URB VALLE SAN LUIS
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-2166
Practice Address - Country:US
Practice Address - Phone:787-390-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3393183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician