Provider Demographics
NPI:1053133389
Name:ALFONSO DELGADO, ELIANY
Entity type:Individual
Prefix:
First Name:ELIANY
Middle Name:
Last Name:ALFONSO 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 1:6351 COW PEN RD UNIT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2237
Mailing Address - Country:US
Mailing Address - Phone:602-388-2509
Mailing Address - Fax:
Practice Address - Street 1:6351 COW PEN RD UNIT 203
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2237
Practice Address - Country:US
Practice Address - Phone:602-388-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician