Healthcare Provider Details

I. General information

NPI: 1881336436
Provider Name (Legal Business Name): VIMALA ELUMALAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512-15
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

20990 VALLEY GREEN DR APT 722
CUPERTINO CA
95014-1848
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-5281
  • Fax:
Mailing address:
  • Phone: 669-246-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: