1346777620 NPI number — POOJA MOHAN PADIGALA

Table of content: POOJA MOHAN PADIGALA (NPI 1346777620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346777620 NPI number — POOJA MOHAN PADIGALA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADIGALA
Provider First Name:
POOJA
Provider Middle Name:
MOHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346777620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/18/2017
NPI Reactivation Date:
02/19/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 S UTICA AVE STE 460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-4041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-579-5749
Provider Business Mailing Address Fax Number:
918-579-5762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 S UTICA AVE STE 460
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-579-5749
Provider Business Practice Location Address Fax Number:
918-579-5762
Provider Enumeration Date:
05/17/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2022008784 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 35450 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)