Basic Information
Provider Information
NPI: 1003001736
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELGADO
FirstName: ROLANDO
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1135
Address2:  
City: YAUCO
State: PR
PostalCode: 006981135
CountryCode: US
TelephoneNumber: 7874257824
FaxNumber:  
Practice Location
Address1: CARR.128 K.M.2.2 BO.SUSUA BAJA
Address2: SUITE 106 YAUCO GALLERY
City: YAUCO
State: PR
PostalCode: 00698
CountryCode: US
TelephoneNumber: 7878565757
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2007
LastUpdateDate: 09/06/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X00338PRY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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