Healthcare Provider Details

I. General information

NPI: 1164505020
Provider Name (Legal Business Name): DELFIN LEONARDO DANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N RIVERSIDE AVE SUITE 210
RIALTO CA
92376-8071
US

IV. Provider business mailing address

1850 N RIVERSIDE AVE SUITE 210
RIALTO CA
92376-8071
US

V. Phone/Fax

Practice location:
  • Phone: 909-562-0012
  • Fax:
Mailing address:
  • Phone: 909-562-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: