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RANMALI KALYANI WALALIYADDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
1448 E CENTER ST, SUITE E, POCATELLO, ID 83201-4132
(208) 234-1300
(208) 234-1333
Mailing address
1448 E CENTER ST, SUITE E, POCATELLO, ID 83201-4132
(208) 234-1300
(208) 234-1333

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-624
ID

Other

Enumeration date
10/16/2006
Last updated
07/08/2007
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