Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 7982782-4405 | UT |
NPI | 1023530854 |
---|---|
Provider Name | Jorge Arturo Delgadillo |
First Address | Provo, UT 84604-6685 |
Second Address | Orem, UT 84057-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 17/03/2018 |