Provider Demographics
NPI:1053766717
Name:DELGADO BRITO, GUSTAVO
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:DELGADO BRITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:
Other - Last Name:DELGADO BRITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:6980 NW 186TH ST # A520
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3171
Mailing Address - Country:US
Mailing Address - Phone:305-319-9105
Mailing Address - Fax:787-801-1784
Practice Address - Street 1:777 E 25TH ST STE 312
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3849
Practice Address - Country:US
Practice Address - Phone:305-392-0380
Practice Address - Fax:305-603-9683
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9334048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner