Provider Demographics
NPI:1730320649
Name:PALLA, BETH
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:PALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19951 MARINER AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1672
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-225-3244
Practice Address - Street 1:19951 MARINER AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1672
Practice Address - Country:US
Practice Address - Phone:310-225-3244
Practice Address - Fax:310-225-3244
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110405207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA110405OtherCA MEDICAL LICENSE