Healthcare Provider Details

I. General information

NPI: 1619922911
Provider Name (Legal Business Name): PITTSBURG-ANTIOCH MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GLADSTONE DR SUITE 3
PITTSBURG CA
94565-5123
US

IV. Provider business mailing address

2220 GLADSTONE DR SUITE 3
PITTSBURG CA
94565-5123
US

V. Phone/Fax

Practice location:
  • Phone: 924-432-3318
  • Fax:
Mailing address:
  • Phone: 924-432-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA50205
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA836250
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG43569
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA82612
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD R DEL RIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-635-2978