Provider Demographics
NPI:1164483723
Name:WARING COURT PEDIATRIC AND ADULT MEDICAL GROUP
Entity Type:Organization
Organization Name:WARING COURT PEDIATRIC AND ADULT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALFORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-941-4498
Mailing Address - Street 1:3230 WARING CT
Mailing Address - Street 2:SUITE J
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-941-4498
Mailing Address - Fax:760-941-6938
Practice Address - Street 1:3230 WARING CT
Practice Address - Street 2:SUITE J
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-941-4498
Practice Address - Fax:760-941-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113589207Q00000X
CAG65272207R00000X
CAG28877208000000X
CAPA19297363AM0700X
CAPA15228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164483723OtherNPI
CAW13873Medicare UPIN