Provider Demographics
NPI:1164505020
Name:DANO, DELFIN LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:DELFIN
Middle Name:LEONARDO
Last Name:DANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8071
Mailing Address - Country:US
Mailing Address - Phone:909-562-0012
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-562-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53019208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A530190Medicaid
CA00A530190Medicaid