Provider Demographics
NPI:1447219902
Name:JELTER, TORIL (MD)
Entity Type:Individual
Prefix:
First Name:TORIL
Middle Name:
Last Name:JELTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TORIL
Other - Middle Name:
Other - Last Name:HAGFORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE B 125
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-587-2505
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5411
Practice Address - Country:US
Practice Address - Phone:925-277-7550
Practice Address - Fax:925-277-7555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics