1205849577 NPI number — ROSARIO RETINO MD FACP

Table of content: ROSARIO RETINO MD FACP (NPI 1205849577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205849577 NPI number — ROSARIO RETINO MD FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RETINO
Provider First Name:
ROSARIO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RETINO
Provider Other First Name:
ROSARIO
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205849577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W G STREET
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91762-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-395-9788
Provider Business Mailing Address Fax Number:
909-395-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W G STREET
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91762-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-395-9788
Provider Business Practice Location Address Fax Number:
909-395-9788
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A51896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)