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Imran Ahmed Mridha

NPI Registration Record

Provider / OrganizationNPIDate Certified
IMRAN AHMED MRIDHA15589705582020-07-24
Entity TypeIndividual
Provider Name Imran Ahmed Mridha PA-S3
Practice Office Address7932 SOUTHSIDE BLVD APT 2409
JACKSONVILLE, FL US
Practice Office Telephone8603711937
Mailing Address7932 SOUTHSIDE BLVD APT 2409
JACKSONVILLE, FL 322567958 US
HPT Codes
CodeLicense NoState
390200000X PRIMARY
OPI Codes

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