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General NPI Number Information
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NPI Number | 1609249374
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Entity Type | Organization
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Legal Business Name | TAMPA BAY RENAL LLC
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 508 S HABANA AVE SUITE 270
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City | TAMPA
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State | FL
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Zip | 33609-4181
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Country | US
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Telephone | 813-388-1732
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Fax |
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Provider Business Mailing Address
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Address Line | 506 S ROYAL PALM WAY
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City | TAMPA
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State | FL
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Zip | 33609-3718
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Country | US
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Telephone | 813-388-1732
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHHAVI GUPTA
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Credential | MD
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Telephone | 813-388-1732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME 115872
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License Number State | FL
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