Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME112280 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME112280 | FL |
NPI | 1063615516 |
---|---|
Provider Name | Dr. Ivanelsie Delgado |
First Address | Port St Lucie, FL 34986-1796 |
Second Address | Port St Lucie, FL 34986-1796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004791700 | (05) | FL |