Healthcare Provider Details

I. General information

NPI: 1164927257
Provider Name (Legal Business Name): DEEPAL HARISH DALAL DPM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 235
BURBANK CA
91505-4563
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 235
BURBANK CA
91505-4563
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-9393
  • Fax: 818-524-2807
Mailing address:
  • Phone: 818-980-9393
  • Fax: 818-524-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: