Provider Demographics
NPI:1144549049
Name:DHALLA, PRABHA (MD)
Entity type:Individual
Prefix:DR
First Name:PRABHA
Middle Name:
Last Name:DHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:92501
Mailing Address - Country:UM
Mailing Address - Phone:951-787-4880
Mailing Address - Fax:951-787-8628
Practice Address - Street 1:4343 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3567
Practice Address - Country:US
Practice Address - Phone:951-787-4880
Practice Address - Fax:951-787-8628
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35185208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice