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NPI Code Detail

MEDICARE: DR. DEVDAS WALI M.D.

MEDICARE: DR. DEVDAS WALI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery PhysicianA78108CA

General Provider Information

NPI Number : 1811909732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEVDAS WALI M.D.
Provider Business Mailing Address
First Line : 350 VINTON AVE
Second Line : 102
City : POMONA
State : CA
Zip : 91767-3000
Country : US
Telephone Number : 909-865-0400
Fax Number : 909-865-0554
Provider Business Practice Location Address
First Line : 155 W WILLOW ST
Second Line :
City : POMONA
State : CA
Zip : 91768-1829
Country : US
Telephone Number : 909-865-2626
Fax Number : 909-865-2010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 11/16/2010

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