Provider Demographics
NPI:1669557872
Name:DHALLA ORTHOPEDIC CENTER
Entity type:Organization
Organization Name:DHALLA ORTHOPEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIR
Authorized Official - Middle Name:PRABHU
Authorized Official - Last Name:DHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-787-4880
Mailing Address - Street 1:4343 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501
Mailing Address - Country:US
Mailing Address - Phone:951-787-4880
Mailing Address - Fax:951-787-8628
Practice Address - Street 1:4343 MARKET ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501
Practice Address - Country:US
Practice Address - Phone:951-787-4880
Practice Address - Fax:951-787-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350690Medicaid
977629OtherWORKERS COMP
977629OtherWORKERS COMP
A88322Medicare UPIN
977629OtherWORKERS COMP