Provider Demographics
NPI:1811909732
Name:WALI, DEVDAS (MD)
Entity type:Individual
Prefix:DR
First Name:DEVDAS
Middle Name:
Last Name:WALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:350 VINTON AVE
Mailing Address - Street 2:102
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3000
Mailing Address - Country:US
Mailing Address - Phone:909-865-0400
Mailing Address - Fax:909-865-0554
Practice Address - Street 1:155 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1829
Practice Address - Country:US
Practice Address - Phone:909-865-2626
Practice Address - Fax:909-865-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78108208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI36281Medicare UPIN