Healthcare Provider Details

I. General information

NPI: 1275875064
Provider Name (Legal Business Name): GUMMADI & DESAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MICHAEL ANGELO SUITE 302
EDINBURG TX
78539-1408
US

IV. Provider business mailing address

2717 MICHAEL ANGELO SUITE 302
EDINBURG TX
78539-1408
US

V. Phone/Fax

Practice location:
  • Phone: 956-668-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. LENIN SMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 941-312-2831