Provider Demographics
NPI:1396090841
Name:DALEL TARTAK M.D., INC
Entity type:Organization
Organization Name:DALEL TARTAK M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DALEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-271-2291
Mailing Address - Street 1:17980 CASTLETON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1851
Mailing Address - Country:US
Mailing Address - Phone:626-854-0148
Mailing Address - Fax:626-820-1180
Practice Address - Street 1:17980 CASTLETON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1851
Practice Address - Country:US
Practice Address - Phone:626-854-0148
Practice Address - Fax:626-820-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty