Healthcare Provider Details

I. General information

NPI: 1104823640
Provider Name (Legal Business Name): RACHNA GULATI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 OUTREACH WAY
NORTH PORT FL
34287-3405
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 901-825-7297
  • Fax: 941-861-3829
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME-89934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: