Basic Information
| Provider Information | |||||||||
| NPI: | 1942286596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | YARA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989480190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035880076 | ||||||||
| FaxNumber: | 3038571179 | ||||||||
| Practice Location | |||||||||
| Address1: | 3896 BEVERLY AVE NE STE 40 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035880076 | ||||||||
| FaxNumber: | 3036829269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 40801 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05289874 | 05 | CO | MEDICAID |