Healthcare Provider Details

I. General information

NPI: 1710556667
Provider Name (Legal Business Name): JOHN DALIVA, DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 FREMONT AVE
MONTCLAIR CA
91763-2320
US

IV. Provider business mailing address

PO BOX 2698
CHINO HILLS CA
91709-0090
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-4751
  • Fax: 909-801-7008
Mailing address:
  • Phone: 909-970-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DALIVA
Title or Position: OWNER
Credential: DO
Phone: 909-970-5700