MEDICARE: DELFIN TIO DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39899	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	239899	OTHER	CA	DELTA DENTAL OF CA.
2	B3989903	OTHER	CA	DENTI-CAL
3	G9818401	OTHER	CA	HEALTHY FAMILIES

General Provider Information

NPI Number	:	1639229123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELFIN TIO DDS INC.

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	DELFIN TIO
Credential	:	DDS
Telephone Number	:	626-443-3915

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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