Provider Demographics
NPI:1679063127
Name:DEL JUNCO, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEL JUNCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WEST STEWART DRIVE SUITE 502
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4227
Mailing Address - Country:US
Mailing Address - Phone:714-919-8141
Mailing Address - Fax:714-919-8142
Practice Address - Street 1:1310 WEST STEWART DRIVE SUITE 502
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4227
Practice Address - Country:US
Practice Address - Phone:714-919-8141
Practice Address - Fax:714-919-8142
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA173376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program