1518138080 NPI number — ALLAM DALATI

Table of content: (NPI 1518138080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518138080 NPI number — ALLAM DALATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLAM DALATI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518138080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1972
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72757-1972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-685-0941
Provider Business Mailing Address Fax Number:
479-621-9960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 MASON MALL STE 6C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-465-1111
Provider Business Practice Location Address Fax Number:
479-621-9960
Provider Enumeration Date:
03/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DALATI
Authorized Official First Name:
ALLAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
707-465-1111

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)