Provider Demographics
NPI:1487484580
Name:DELGADO HIPP, ADONIA CORAIMA
Entity type:Individual
Prefix:
First Name:ADONIA
Middle Name:CORAIMA
Last Name:DELGADO HIPP
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 1:330 PARK VIEW TER APT 207
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4670
Mailing Address - Country:US
Mailing Address - Phone:510-393-7635
Mailing Address - Fax:
Practice Address - Street 1:1266 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2247
Practice Address - Country:US
Practice Address - Phone:510-882-7791
Practice Address - Fax:510-531-0258
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist