Provider Demographics
NPI:1215108774
Name:DALATI, ALLAM (CPO)
Entity type:Individual
Prefix:
First Name:ALLAM
Middle Name:
Last Name:DALATI
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:ORTHO
Other - Middle Name:
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1972
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1972
Mailing Address - Country:US
Mailing Address - Phone:707-465-1111
Mailing Address - Fax:479-621-9960
Practice Address - Street 1:1080 MASON MALL STE 6C
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4335
Practice Address - Country:US
Practice Address - Phone:707-465-1111
Practice Address - Fax:479-621-9960
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4086630002Medicare NSC