Provider Demographics
NPI:1912938085
Name:DEPALA, ARMANDO V JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ARMANDO
Middle Name:V
Last Name:DEPALA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1550 A PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-769-7403
Mailing Address - Fax:707-769-0134
Practice Address - Street 1:1550 A PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-769-7403
Practice Address - Fax:707-769-0134
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA52324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523240Medicaid