Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3830 | FL |
NPI | 1043652290 |
---|---|
Provider Name | Prerna Alfa Mall |
First Address | Lake Wales, FL 33853-4146 |
Second Address | Lake Wales, FL 33853-4146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 06/04/2017 |