MEDICARE: DILIP AKA DURGESH J TILALA

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
1	183500000X	Pharmacist	81159	CA

General Provider Information

NPI Number	:	1952948960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILIP AKA DURGESH J TILALA

Provider Business Mailing Address
First Line	:	15867 HIGH KNOLL DR UNIT 80
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-4273
Country	:	US
Telephone Number	:	714-873-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	15867 HIGH KNOLL DR UNIT 80
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-4273
Country	:	US
Telephone Number	:	714-873-5450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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