Individual
PRERNA ALFA MALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
408 S 1ST ST, LAKE WALES, FL 33853-4146
(863) 676-1710
Mailing address
408 S 1ST ST, LAKE WALES, FL 33853-4146
(863) 676-1710
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3830
FL
Other
Enumeration date
07/29/2013
Last updated
04/06/2017
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