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General NPI Number Information
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NPI Number | 1033498837
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Entity Type | Organization
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Legal Business Name | GARDENS FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 3365 BURNS RD STUITE 217
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4326
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Country | US
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Telephone | 561-627-7433
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Fax | 561-775-1055
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Provider Business Mailing Address
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Address Line | 3365 BURNS RD STUITE 217
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4326
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Country | US
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Telephone | 561-627-7433
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Fax | 561-775-1055
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. PRABHAVATHI VIRALAM
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Credential | MD
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Telephone | 561-627-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME63002
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License Number State | FL
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