Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5335 | PR |
NPI | 1023302403 |
---|---|
Provider Name | Dr. Edgardo Delgado Mejias |
First Address | Ponce, PR 00730 |
Second Address | Ponce, PR 00717-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |