Provider Demographics
NPI:1205849577
Name:RETINO, ROSARIO (MD FACP)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:RETINO
Suffix:
Gender:F
Credentials:MD FACP
Other - Prefix:MS
Other - First Name:ROSARIO
Other - Middle Name:
Other - Last Name:RETINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:320 W G STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3233
Mailing Address - Country:US
Mailing Address - Phone:909-395-9788
Mailing Address - Fax:909-395-9788
Practice Address - Street 1:320 W G STREET
Practice Address - Street 2:STE 101
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3233
Practice Address - Country:US
Practice Address - Phone:909-395-9788
Practice Address - Fax:909-395-9788
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51896208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics