Provider Demographics
NPI:1275761371
Name:DEL RE, ANGELO MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:MICHAEL
Last Name:DEL RE
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 1:9333 GENESEE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2139
Mailing Address - Country:US
Mailing Address - Phone:858-966-8036
Mailing Address - Fax:
Practice Address - Street 1:9333 GENESEE AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2139
Practice Address - Country:US
Practice Address - Phone:858-215-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129572208000000X
NC2012-01200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics