Healthcare Provider Details

I. General information

NPI: 1205849577
Provider Name (Legal Business Name): ROSARIO RETINO MD FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSARIO RETINO MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/15/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 CENTRAL AVE STE B
CHINO CA
91710
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 300
LAGUNA HILLS CA
92653-3628
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-6076
  • Fax: 909-395-9787
Mailing address:
  • Phone: 949-599-2434
  • Fax: 949-599-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: