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General NPI Number Information
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NPI Number | 1336365907
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Entity Type | Organization
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Legal Business Name | NIRMALA INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 18928 N. DALE MABRY HWY STE 102
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City | LUTZ
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State | FL
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Zip | 33548
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Country | US
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Telephone | 813-948-2679
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Fax | 813-948-2694
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Provider Business Mailing Address
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Address Line | 18928 N. DALE MABRY HWY STE 102
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City | LUTZ
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State | FL
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Zip | 33548
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Country | US
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Telephone | 813-948-2679
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Fax | 813-948-2694
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. PAYAL PATEL
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Credential | M.D.
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Telephone | 813-758-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME90168
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License Number State | FL
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