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General NPI Number Information
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NPI Number | 1275822256
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Entity Type | Individual
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Provider Name | NISHA BALA KRISHNAN DPM
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 3404 N LECANTO HWY SUITE A
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-3569
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Country | US
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Telephone | 352-513-4867
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Fax | 888-314-9873
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Provider Business Mailing Address
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Address Line | 3404 N LECANTO HWY SUITE A
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-3569
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Country | US
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Telephone | 352-513-4867
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Fax | 888-314-9873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3609
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License Number State | FL
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