Individual
ELISHA PRAVETA MAHILAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 724-6124
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2023-0620
NM
390200000X
Student in an Organized Health Care Education/Training Program
TRN30313
FL
Other
Enumeration date
05/19/2020
Last updated
07/12/2023
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