Healthcare Provider Details

I. General information

NPI: 1205966843
Provider Name (Legal Business Name): RONALD DALLA TOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 WHITTIER BLVD
PICO RIVERA CA
90660-2521
US

IV. Provider business mailing address

441 S 3RD ST
MONTEBELLO CA
90640-5601
US

V. Phone/Fax

Practice location:
  • Phone: 562-695-0737
  • Fax: 562-695-0413
Mailing address:
  • Phone: 323-887-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: