Basic Information
| Provider Information | |||||||||
| NPI: | 1871634162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALLA TOR | ||||||||
| FirstName: | NELSON | ||||||||
| MiddleName: | EDGAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12291 WASHINGTON BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626982541 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12291 WASHINGTON BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5627894340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A64802 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.