Provider Demographics
NPI:1659540102
Name:SMITA MALHOTRA
Entity Type:Organization
Organization Name:SMITA MALHOTRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-821-8829
Mailing Address - Street 1:1650 SAN PABLO RD S
Mailing Address - Street 2:STE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1036
Mailing Address - Country:US
Mailing Address - Phone:904-821-8829
Mailing Address - Fax:904-821-8830
Practice Address - Street 1:1650 SAN PABLO RD S
Practice Address - Street 2:STE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1036
Practice Address - Country:US
Practice Address - Phone:904-821-8829
Practice Address - Fax:904-821-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies