MEDICARE: SANJAY S LULLA DO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	S2630	TX

General Provider Information

NPI Number	:	1700229234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY S LULLA DO

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17903 W LAKE HOUSTON PKWY STE 201
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346
Country	:	US
Telephone Number	:	281-812-1846
Fax Number	:	281-812-2776

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

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	07/02/2019

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