Provider Demographics
NPI:1801002092
Name:SALLOWM, DELPHIN (MD)
Entity Type:Individual
Prefix:
First Name:DELPHIN
Middle Name:
Last Name:SALLOWM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST # A1120
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-558-4773
Mailing Address - Fax:909-558-0479
Practice Address - Street 1:11175 CAMPUS ST # A1120
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-558-4773
Practice Address - Fax:909-558-0479
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI607292084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology