Octavio Delgado, PSYCHOLOGIST

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

License

PSY 12523 Issued in CA

Practice address

111 S Garfield Ave
Suite 101
Montebello, CA 90640-3800

Phone

(323) 890-0180

Fax

(323) 890-1167

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastside Psychological Services, Inc.

  • Public Health or Welfare Agency
  • Montebello, CA
  • NPI 1972926442
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083766489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230548",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920230548",
            "telephone_number": "323-890-0180",
            "fax_number": "323-890-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S GARFIELD AVE",
            "address_2": "SUITE 101",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403800",
            "telephone_number": "323-890-0180",
            "fax_number": "323-890-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELGADO",
        "first_name": "OCTAVIO",
        "name_prefix": "Dr.",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY 12523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "148254",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mia De la Torre
• Alexandre Andrade De Santanna
• Mosen Michael Defrawy, MD
• Carlos Miguel Delgado Jr., DDS
• Nora Marisa Delgado, M.S., CCC-SLP
• Dennis K Kuwaye Jr DDS Inc
• Dental Care of Montebello
• Dentalville
• Derhartounian Dental Corporation
• Harmik Derhartounian, DDS

• Group Psychotherapy Psychologist in Montebello, CA
• Providers in Montebello, CA by specialty
• Group Psychotherapy Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.