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General NPI Number Information
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NPI Number | 1780684639
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Entity Type | Individual
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Provider Name | JOHN GREGORY DALLE D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 801 S MAIN ST STE 101&205
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City | CORONA
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State | CA
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Zip | 92882-3402
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Country | US
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Telephone | 951-238-6071
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Fax | 951-351-1025
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Provider Business Mailing Address
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Address Line | PO BOX 101418
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City | PASADENA
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State | CA
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Zip | 91189-0025
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Country | US
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Telephone | 844-866-2718
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Fax | 310-966-8571
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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 | 54676
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20A8441
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License Number State | CA
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