Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME0064254 | FL |
NPI | 1326058702 |
---|---|
Provider Name | Dr. Valli Subramanian |
First Address | Clearwater, FL 33756-3902 |
Second Address | Clearwater, FL 33756-3902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F43175 | (02) | FL |