Healthcare Provider Details

I. General information

NPI: 1376723205
Provider Name (Legal Business Name): CHITRA V RAJPAL M.B.B.S.,M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 SAN JOSE BLVD STE 24
JACKSONVILLE FL
32257-5857
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 904-337-2055
  • Fax: 904-337-2056
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME108505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: