Provider Demographics
NPI:1154700540
Name:ITALIYA, DISHABEN VALLABHBHAI (MD)
Entity type:Individual
Prefix:
First Name:DISHABEN
Middle Name:VALLABHBHAI
Last Name:ITALIYA
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 1:45 E RIVER PARK PL W STE 507
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1565
Mailing Address - Country:US
Mailing Address - Phone:559-603-7367
Mailing Address - Fax:559-603-7366
Practice Address - Street 1:45 E RIVER PARK PL W STE 507
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1565
Practice Address - Country:US
Practice Address - Phone:559-603-7367
Practice Address - Fax:559-603-7366
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172773207R00000X
AL37248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine