Healthcare Provider Details

I. General information

NPI: 1053590737
Provider Name (Legal Business Name): DENNIS W DEL PAINE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 CARRINGTON CIRCLE
STOCKTON CA
95210-3516
US

IV. Provider business mailing address

5309 CARRINGTON CIRCLE
STOCKTON CA
95210-3516
US

V. Phone/Fax

Practice location:
  • Phone: 209-951-4100
  • Fax: 209-951-2324
Mailing address:
  • Phone: 209-951-4100
  • Fax: 209-951-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG37345
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG37345
License Number StateCA

VIII. Authorized Official

Name: MS. KRISTIE D TOLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-951-4100