Provider Demographics
NPI:1174263156
Name:BABOOLAL, VISHNU
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:BABOOLAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 CORALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8570
Mailing Address - Country:US
Mailing Address - Phone:407-466-5238
Mailing Address - Fax:
Practice Address - Street 1:17850 CORALWOOD LN
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8570
Practice Address - Country:US
Practice Address - Phone:407-466-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL21000455184343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)