Provider Demographics
NPI:1366168510
Name:DELANO, AGUSTIN JOSE
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:JOSE
Last Name:DELANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48880 DENTON RD APT 31
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2071
Mailing Address - Country:US
Mailing Address - Phone:216-544-7106
Mailing Address - Fax:
Practice Address - Street 1:48880 DENTON RD APT 31
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-2071
Practice Address - Country:US
Practice Address - Phone:216-544-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician