Healthcare Provider Details

I. General information

NPI: 1831967058
Provider Name (Legal Business Name): DR NIRMALA TUMARADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5728
US

IV. Provider business mailing address

6438 WHITE OLEANDER CIR E
LAKE CHARLES LA
70605-0377
US

V. Phone/Fax

Practice location:
  • Phone: 374-333-0762
  • Fax:
Mailing address:
  • Phone: 205-585-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIRMALA TUMARADA
Title or Position: NEUROLOGIST
Credential: MD
Phone: 205-585-7930