Provider Demographics
NPI:1528103298
Name:JARIAL, RAVINDER S (DO)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:S
Last Name:JARIAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EVERNIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5431
Mailing Address - Country:US
Mailing Address - Phone:561-249-0390
Mailing Address - Fax:561-249-0421
Practice Address - Street 1:410 EVERNIA ST STE 109
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5431
Practice Address - Country:US
Practice Address - Phone:561-249-0390
Practice Address - Fax:561-249-0421
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012845208200000X, 208600000X
OH34-007972208200000X, 208600000X
FLOS9321208200000X
TXN6386208600000X, 208200000X
FLOS 9321208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54981OtherUPIN