Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G50089 | CA |
NPI | 1073557757 |
---|---|
Provider Name | Dr. Michael J. Del Rio |
First Address | Redlands, CA 92373 |
Second Address | Poplar Bluff, MO 63901-1573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 01/09/2020 |