Basic Information
| Provider Information | |||||||||
| NPI: | 1225523731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANFRANCO DELGADO | ||||||||
| FirstName: | ELYN | ||||||||
| MiddleName: | ELIEZER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | 9542894682 | ||||||||
| Practice Location | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | 9542894682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14712 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME158264 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 854409 | 05 | SC | MEDICAID | SCK5046067 | 01 | SC | MEDICARE PIN | OTHER | SCK504J577 | 01 | SC | MEDICARE PIN | OTHER | SCK5046084 | 01 | SC | MEDICARE PIN | OTHER |