Provider Demographics
NPI:1861210668
Name:DELGADO, JORGE MANUEL JR (RDH)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:MANUEL
Last Name:DELGADO
Suffix:JR
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-3888
Mailing Address - Country:US
Mailing Address - Phone:909-953-1225
Mailing Address - Fax:
Practice Address - Street 1:1655 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1427
Practice Address - Country:US
Practice Address - Phone:909-361-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist