Provider Demographics
NPI:1083797963
Name:E.P. DELFIN, JR., M.D.
Entity Type:Organization
Organization Name:E.P. DELFIN, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELEUTERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELFIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-864-2544
Mailing Address - Street 1:13330 BLOOMFIELD AVE
Mailing Address - Street 2:112
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3251
Mailing Address - Country:US
Mailing Address - Phone:562-864-2544
Mailing Address - Fax:562-864-8908
Practice Address - Street 1:13330 BLOOMFIELD AVE
Practice Address - Street 2:112
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3251
Practice Address - Country:US
Practice Address - Phone:562-864-2544
Practice Address - Fax:562-864-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34020207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34020OtherLICENSE NUMBER
CA00A340200Medicaid
CAW8089Medicare ID - Type Unspecified
CA00A340200Medicaid