Basic Information
Provider Information
NPI: 1790701191
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DALI
FirstName: PILU
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11773
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852480013
CountryCode: US
TelephoneNumber: 4809077707
FaxNumber: 4809077097
Practice Location
Address1: 1301 S CRISMON RD
Address2:  
City: MESA
State: AZ
PostalCode: 852093767
CountryCode: US
TelephoneNumber: 4803586100
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2006
LastUpdateDate: 12/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X38127AZY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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