Healthcare Provider Details

I. General information

NPI: 1740776897
Provider Name (Legal Business Name): DAVID VADALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 DUVAL RD STE 102
AUSTIN TX
78759-3550
US

IV. Provider business mailing address

408 W 45TH ST
AUSTIN TX
78751-3014
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-5800
  • Fax:
Mailing address:
  • Phone: 512-451-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberU2348
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: