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General NPI Number Information
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NPI Number | 1912938085
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Entity Type | Individual
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Provider Name | ARMANDO V DEPALA JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 1550 A PROFESSIONAL DRIVE
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City | PETALUMA
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State | CA
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Zip | 94954
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Country | US
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Telephone | 707-769-7403
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Fax | 707-769-0134
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Provider Business Mailing Address
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Address Line | 1550 A PROFESSIONAL DRIVE
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City | PETALUMA
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State | CA
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Zip | 94954
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Country | US
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Telephone | 707-769-7403
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Fax | 707-769-0134
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A52324
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License Number State | CA
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