1639229123 NPI number — DELFIN TIO DDS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639229123 NPI number — DELFIN TIO DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELFIN TIO DDS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639229123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 SANTA ANITA AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SOUTH EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91733-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-443-3915
Provider Business Mailing Address Fax Number:
626-444-2086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SANTA ANITA AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SOUTH EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91733-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-443-3915
Provider Business Practice Location Address Fax Number:
626-444-2086
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TIO
Authorized Official First Name:
DELFIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-443-3915

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  39899 , 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)

  • Identifier: 239899 . This is a "DELTA DENTAL OF CA." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B3989903 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G9818401 . This is a "HEALTHY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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