Healthcare Provider Details

I. General information

NPI: 1295648715
Provider Name (Legal Business Name): DELTA DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27780 JEFFERSON AVE STE 16
TEMECULA CA
92590-6602
US

IV. Provider business mailing address

27780 JEFFERSON AVE STE 16
TEMECULA CA
92590-6602
US

V. Phone/Fax

Practice location:
  • Phone: 951-403-3424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DILDAR AHMAD
Title or Position: OWNER
Credential:
Phone: 951-403-3424