Healthcare Provider Details

I. General information

NPI: 1609017532
Provider Name (Legal Business Name): DR. PRITHA BANKIM DALAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHILDRENS WAY STE 300
SAN DIEGO CA
92123-4232
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 868-966-8974
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberMD449978
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberA132097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: