Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | PA11124 | CA |
NPI | 1568529048 |
---|---|
Provider Name | Connie Delgado |
First Address | Indio, CA 92201-2963 |
Second Address | Coachella, CA 92236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 29/03/2016 |