Healthcare Provider Details

I. General information

NPI: 1144354440
Provider Name (Legal Business Name): SUJAL RANGWALLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD STE 200
AUSTIN TX
78723-3078
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD STE 200
AUSTIN TX
78723-3078
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1810
  • Fax: 512-628-1811
Mailing address:
  • Phone: 512-628-1810
  • Fax: 512-628-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN3263
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberN3263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: