Healthcare Provider Details

I. General information

NPI: 1346343985
Provider Name (Legal Business Name): RUPAL MANISH DALAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 VINEYARD PARKWAY
SAN JOSE CA
95135-2066
US

IV. Provider business mailing address

3273 VINEYARD PARKWAY
SAN JOSE CA
95135-2066
US

V. Phone/Fax

Practice location:
  • Phone: 408-531-1676
  • Fax:
Mailing address:
  • Phone: 408-531-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA069705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: