Healthcare Provider Details

I. General information

NPI: 1962361105
Provider Name (Legal Business Name): DEL RE MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 GENESEE AVE STE 250
SAN DIEGO CA
92121-2139
US

IV. Provider business mailing address

315 S COAST HIGHWAY 101 STE U148
ENCINITAS CA
92024-3543
US

V. Phone/Fax

Practice location:
  • Phone: 858-215-1144
  • Fax: 760-257-1951
Mailing address:
  • Phone: 843-834-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELO MICHAEL DEL RE
Title or Position: PHYSICIAN/DIRECTOR/OWNER
Credential: MD
Phone: 843-834-0100