Organization
TAMPA BAY RENAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHHAVI GUPTA MD (MANAGER)
(813) 388-1732
Entity
Organization
Contact information
Practice address
508 S HABANA AVE, SUITE 270, TAMPA, FL 33609-4181
(813) 388-1732
Mailing address
506 S ROYAL PALM WAY, TAMPA, FL 33609-3718
(813) 388-1732
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME 115872
FL
Other
Enumeration date
11/03/2015
Last updated
11/03/2015
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