Provider Demographics
NPI:1386388833
Name:LAKHATARIYA, KHUSHBOO MUKESHBHAI
Entity type:Individual
Prefix:
First Name:KHUSHBOO
Middle Name:MUKESHBHAI
Last Name:LAKHATARIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 EAST MARKET STREET, 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-841-3235
Practice Address - Fax:330-841-9645
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program