Provider Demographics
NPI:1396504007
Name:SGARS HOLDINGS PLLC
Entity type:Organization
Organization Name:SGARS HOLDINGS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANGALYA
Authorized Official - Middle Name:SIRISHA
Authorized Official - Last Name:TIRTHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-893-6136
Mailing Address - Street 1:6042 MARSH TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4655
Mailing Address - Country:US
Mailing Address - Phone:201-893-6136
Mailing Address - Fax:
Practice Address - Street 1:2943 ALLEGRA WAY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-922-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SGARS HOLDINGS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-15
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty