Healthcare Provider Details

I. General information

NPI: 1831578350
Provider Name (Legal Business Name): ETERNAL IMPRESSIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NORTHWEST BLVD 200-2
GRANDVIEW HEIGHTS OH
43212-3856
US

IV. Provider business mailing address

751 NORTHWEST BLVD 200-2
GRANDVIEW HEIGHTS OH
43212-3856
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-2504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAKESH NANDA
Title or Position: OWNER
Credential: MD
Phone: 614-421-7546