Healthcare Provider Details

I. General information

NPI: 1891760484
Provider Name (Legal Business Name): SEEMA MITAL KUBAREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEEMA MITAL MD

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6352 RIVER RD
NEW PORT RICHEY FL
34652-2241
US

IV. Provider business mailing address

6352 RIVER RD
NEW PORT RICHEY FL
34652-2241
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax: 253-968-0384
Mailing address:
  • Phone: 253-968-3066
  • Fax: 253-968-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME81370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: