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General NPI Number Information
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NPI Number | 1760568901
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Entity Type | Individual
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Provider Name | WALTER D DISHELL MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE 550
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City | ENCINO
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State | CA
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Zip | 91436-4314
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Country | US
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Telephone | 818-986-7900
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Fax | 818-986-7952
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD SUITE 550
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City | ENCINO
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State | CA
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Zip | 91436-4314
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Country | US
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Telephone | 818-986-7900
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Fax | 818-986-7952
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | C274780
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License Number State | CA
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