Healthcare Provider Details

I. General information

NPI: 1548985153
Provider Name (Legal Business Name): KARINA DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 INDIANA AVE STE 155
RIVERSIDE CA
92506-4225
US

IV. Provider business mailing address

3652 E MOONLIGHT ST UNIT 90
ONTARIO CA
91761-2795
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35274-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: