Healthcare Provider Details

I. General information

NPI: 1669557872
Provider Name (Legal Business Name): DHALLA ORTHOPEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 MARKET ST
RIVERSIDE CA
92501
US

IV. Provider business mailing address

4343 MARKET ST
RIVERSIDE CA
92501
US

V. Phone/Fax

Practice location:
  • Phone: 951-787-4880
  • Fax: 951-787-8628
Mailing address:
  • Phone: 951-787-4880
  • Fax: 951-787-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIR PRABHU DHALLA
Title or Position: PRESIDENT
Credential: MD
Phone: 951-787-4880