MEDICARE: DR. DEEPAL HARISH DALAL DPM, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E5739	CA

General Provider Information

NPI Number	:	1164927257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPAL HARISH DALAL DPM, MS

Provider Business Mailing Address
First Line	:	191 S BUENA VISTA ST STE 235
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4563
Country	:	US
Telephone Number	:	818-980-9393
Fax Number	:	818-524-2807

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST STE 235
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4563
Country	:	US
Telephone Number	:	818-980-9393
Fax Number	:	818-524-2807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	04/03/2023

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