Healthcare Provider Details

I. General information

NPI: 1730320649
Provider Name (Legal Business Name): DR. BETH PALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

IV. Provider business mailing address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3244
  • Fax: 310-225-3244
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-225-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA110405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: