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General NPI Number Information
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NPI Number | 1629368261
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Entity Type | Individual
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Provider Name | VIVEK DALAL MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2011
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 465 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3320
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Country | US
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Telephone | 850-339-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 2184 W RIVER SPRINGS AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-6737
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Country | US
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Telephone | 850-339-2355
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 138304
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License Number State | CA
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