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General NPI Number Information
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NPI Number | 1659658896
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Entity Type | Organization
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Legal Business Name | SANJIV WALIA MD PA
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 2215 NEBRASKA AVE SUITE 1F2
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City | FORT PIERCE
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State | FL
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Zip | 34950-4864
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Country | US
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Telephone | 772-466-1977
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Fax | 772-466-2433
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Provider Business Mailing Address
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Address Line | 2215 NEBRASKA AVE SUITE 1F2
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City | FORT PIERCE
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State | FL
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Zip | 34950-4864
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Country | US
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Telephone | 772-466-1977
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Fax | 772-466-2433
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANJIV WALIA
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Credential | M.D.
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Telephone | 772-466-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME0042047
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License Number State | FL
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