Healthcare Provider Details

I. General information

NPI: 1083797963
Provider Name (Legal Business Name): E.P. DELFIN, JR., M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13330 BLOOMFIELD AVE 112
NORWALK CA
90650-3251
US

IV. Provider business mailing address

13330 BLOOMFIELD AVE 112
NORWALK CA
90650-3251
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-2544
  • Fax: 562-864-8608
Mailing address:
  • Phone: 562-864-2544
  • Fax: 562-864-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA34020
License Number StateCA

VIII. Authorized Official

Name: ELEUTERIO DELFIN JR.
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 562-864-2544