Provider Demographics
NPI:1053534065
Name:DELGADO, ILEANA
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name: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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0745
Mailing Address - Country:US
Mailing Address - Phone:787-893-0975
Mailing Address - Fax:787-893-3984
Practice Address - Street 1:CALLE CRISTOBAL COLON #54
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0745
Practice Address - Country:US
Practice Address - Phone:787-893-0975
Practice Address - Fax:787-893-3984
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5584183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5584OtherPHARMACY ASSISTANT