Basic Information
| Provider Information | |||||||||
| NPI: | 1093827644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADO PONS | ||||||||
| FirstName: | SEIDY | ||||||||
| MiddleName: | IDALIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6675 WESTWOOD BLVD STE 475 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328216027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078450330 | ||||||||
| FaxNumber: | 8889721750 | ||||||||
| Practice Location | |||||||||
| Address1: | 4543 PLEASANT HILL RD SPC A | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347593406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079337900 | ||||||||
| FaxNumber: | 3214370072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16135 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN1319 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.