Provider Demographics
NPI:1730765785
Name:YATHALI, ALEEMA
Entity type:Individual
Prefix:
First Name:ALEEMA
Middle Name:
Last Name:YATHALI
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 1:205 SE 16TH AVE APT 17E
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8632
Mailing Address - Country:US
Mailing Address - Phone:561-676-3180
Mailing Address - Fax:
Practice Address - Street 1:205 SE 16TH AVE APT 17E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8632
Practice Address - Country:US
Practice Address - Phone:561-676-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program