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General NPI Number Information
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NPI Number | 1811909732
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Entity Type | Individual
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Provider Name | DEVDAS WALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 155 W WILLOW ST
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City | POMONA
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State | CA
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Zip | 91768-1829
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Country | US
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Telephone | 909-865-2626
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Fax | 909-865-2010
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Provider Business Mailing Address
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Address Line | 350 VINTON AVE 102
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City | POMONA
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State | CA
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Zip | 91767-3000
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Country | US
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Telephone | 909-865-0400
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Fax | 909-865-0554
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A78108
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License Number State | CA
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