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General NPI Number Information
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NPI Number | 1497737639
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN DALSASO MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 2700 DOLBEER ST ST. JOSEPH HOSPITAL
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City | EUREKA
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State | CA
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Zip | 95501-4736
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Country | US
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Telephone | 707-442-7814
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Fax | 707-445-3710
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Provider Business Mailing Address
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Address Line | PO BOX 6428 HUMBOLDT RADIOLOGY MEDICAL GROUP,INC.
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City | EUREKA
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State | CA
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Zip | 95502-6428
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Country | US
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Telephone | 707-442-7814
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Fax | 707-445-3710
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 224783
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License Number State | MA
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