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General NPI Number Information
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NPI Number | 1396090841
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Entity Type | Organization
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Legal Business Name | DALEL TARTAK M.D., INC
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 17980 CASTLETON ST UNIT 1
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748-1851
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Country | US
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Telephone | 626-854-0148
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Fax | 626-820-1180
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Provider Business Mailing Address
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Address Line | 17980 CASTLETON ST UNIT 1
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748-1851
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Country | US
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Telephone | 626-854-0148
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Fax | 626-820-1180
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. DALEL TARTAK
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Credential | M.D.
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Telephone | 714-271-2291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G63313
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License Number State | CA
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