Healthcare Provider Details

I. General information

NPI: 1740503986
Provider Name (Legal Business Name): NISHA SARAN D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W MILLER ST
DILLEY TX
78017-3818
US

IV. Provider business mailing address

PO BOX 576
DILLEY TX
78017-0576
US

V. Phone/Fax

Practice location:
  • Phone: 817-682-2043
  • Fax:
Mailing address:
  • Phone: 817-682-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL5894
License Number StateTX

VIII. Authorized Official

Name: DR. NISHA M SARAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 817-682-2043