Healthcare Provider Details

I. General information

NPI: 1245754399
Provider Name (Legal Business Name): DIPA PATOLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040
US

V. Phone/Fax

Practice location:
  • Phone: 877-462-2582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: