Doctor Name: | SUNITHA MALLA |
NPI Number: | 1346534302 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 135 River North Blvd Stephenville, TX - 764011804 |
Business Phone Number: | 2549652810 |
Business Fax Number: | 2549655440 |
Mailing Address: | 1100 W Reynosa Ave, DE LEON |
State: | TX |
Postal Code: | 764441630 |
Phone Number: | 2458935895 |
Fax Number: | 2548935222 |
NPI Enumeration Date: | 06/07/2011 |
NPI Last Update Date: | 08/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |