Provider Demographics
NPI:1790364495
Name:PALATHINGAL BAVA, EJAS
Entity Type:Individual
Prefix:
First Name:EJAS
Middle Name:
Last Name:PALATHINGAL BAVA
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 1:2895 CROWNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5375
Mailing Address - Country:US
Mailing Address - Phone:713-794-6109
Mailing Address - Fax:
Practice Address - Street 1:1824 6TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-5802
Practice Address - Country:US
Practice Address - Phone:713-794-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program