1851042709 NPI number — MR. ARMANDO GILBERT DEL REAL JR.

Table of content: MR. ARMANDO GILBERT DEL REAL JR. (NPI 1851042709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851042709 NPI number — MR. ARMANDO GILBERT DEL REAL JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL REAL
Provider First Name:
ARMANDO
Provider Middle Name:
GILBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEL REAL
Provider Other First Name:
ARMANDO
Provider Other Middle Name:
GILBERT
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
DYNASTY GROUP USA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851042709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14251 FIRESTONE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MIRADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90638-5525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-587-3518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14251 FIRESTONE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MIRADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90638-5525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-587-3518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2022

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: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com