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General NPI Number Information
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NPI Number | 1437270279
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Entity Type | Individual
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Provider Name | MABALA G NYALUGWE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 20050 HARVARD AVE
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City | WARRENSVILLE HEIGHTS
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State | OH
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Zip | 44122-6816
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Country | US
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Telephone | 216-291-5151
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Fax | 216-291-4460
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Provider Business Mailing Address
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Address Line | 16781 CHAGRIN BLVD # 549
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-3721
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Country | US
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Telephone | 765-765-8055
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01043016A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.135083
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License Number State | OH
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