Provider Demographics
NPI:1609933845
Name:DILETTERA, DAVID CARLTON (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CARLTON
Last Name:DILETTERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:323-728-7271
Mailing Address - Fax:323-728-0108
Practice Address - Street 1:2390 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:323-728-7271
Practice Address - Fax:323-728-0108
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1940Medicare PIN
B58253Medicare UPIN