MEDICARE: GORAL TRIVEDI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	225700000X	Massage Therapist
2	101YM0800X	Mental Health Counselor	TX
3	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1356290985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORAL TRIVEDI

Provider Business Mailing Address
First Line	:	12280 BROADWAY ST STE 3121
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7868
Country	:	US
Telephone Number	:	713-623-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	12280 BROADWAY ST STE 3121
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7868
Country	:	US
Telephone Number	:	713-623-0005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ GORAL TRIVEDI ” Practice Location

Language	Start Address	Practice Location

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