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NPI Code Detail

MEDICARE: MRS. MAILI VELEZ-DALLA TOR M.D.

MEDICARE: MRS. MAILI VELEZ-DALLA TOR 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
1207QH0002XHospice and Palliative Medicine (Family Medicine) PhysicianA71918CA
2207Q00000XFamily Medicine PhysicianA71918CA

General Provider Information

NPI Number : 1992763619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAILI VELEZ-DALLA TOR M.D.
Provider Business Mailing Address
First Line : 1770 N ORANGE GROVE AVE
Second Line : SUITE101
City : POMONA
State : CA
Zip : 91767-3027
Country : US
Telephone Number : 909-469-9494
Fax Number : 909-620-7285
Provider Business Practice Location Address
First Line : 1135 S SUNSET AVE STE 401
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-3921
Country : US
Telephone Number : 626-732-8391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 02/02/2024

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