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General NPI Number Information
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NPI Number | 1740308683
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Entity Type | Organization
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Legal Business Name | DHALLA ORTHOPEDIC CENTER INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 4343 MARKET ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3517
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Country | US
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Telephone | 951-787-4880
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Fax | 951-787-8628
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Provider Business Mailing Address
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Address Line | 4343 MARKET ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3517
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Country | US
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Telephone | 951-787-4880
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Fax | 951-787-8628
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIR PRABHU DHALLA
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Credential | MD
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Telephone | 951-787-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | CA
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