Healthcare Provider Details

I. General information

NPI: 1750334660
Provider Name (Legal Business Name): DELTA PEDIATRICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 LONE TREE WAY STE. 211
ANTIOCH CA
94509-6249
US

IV. Provider business mailing address

3903 LONE TREE WAY STE. 211
ANTIOCH CA
94509-6249
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-7200
  • Fax: 925-754-7290
Mailing address:
  • Phone: 925-754-7200
  • Fax: 925-754-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA313250
License Number StateCA

VIII. Authorized Official

Name: MR. ABBAS MAHDAVI
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 925-754-7200