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Gerald E Dalgleish

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NPI Number Detailed Information

Provider Information:

Name: Gerald E Dalgleish
Gender: M
Provider License Number If Given: G29090

NPI Information:

NPI: 1073508511
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/19/2018

Provider Business Mailing Address:

Address: 5767 W CENTURY BLVD STE 400
Los Angeles, CA 90045
Phone Number: 3103018707
Fax Number: 3103018751

Provider Business Practice Location Address:

Address: 10833 LE CONTE AVE
Los Angeles, CA 90095
Phone Number: 3107947953
Fax Number:

Provider Taxonomy:

Primary: 207ZP0102X
Secondary (if any):
State: CA

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