Provider Demographics
NPI:1619510765
Name:DINAN, LOTUS YAMNA
Entity Type:Individual
Prefix:
First Name:LOTUS
Middle Name:YAMNA
Last Name:DINAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 RIALTO AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5050
Mailing Address - Country:US
Mailing Address - Phone:352-515-6329
Mailing Address - Fax:352-453-5547
Practice Address - Street 1:14505 RIALTO AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5050
Practice Address - Country:US
Practice Address - Phone:352-515-6329
Practice Address - Fax:352-453-5547
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications