Healthcare Provider Details

I. General information

NPI: 1336365907
Provider Name (Legal Business Name): NIRMALA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18928 N. DALE MABRY HWY STE 102
LUTZ FL
33548
US

IV. Provider business mailing address

18928 N. DALE MABRY HWY STE 102
LUTZ FL
33548
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-2679
  • Fax: 813-948-2694
Mailing address:
  • Phone: 813-948-2679
  • Fax: 813-948-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90168
License Number StateFL

VIII. Authorized Official

Name: DR. PAYAL PATEL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 813-758-1749