Healthcare Provider Details

I. General information

NPI: 1780174268
Provider Name (Legal Business Name): SWAROOPA PULIVARTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 NORTHWEST FWY STE 360
CYPRESS TX
77433-8028
US

IV. Provider business mailing address

27700 NORTHWEST FWY STE 360
CYPRESS TX
77433-8028
US

V. Phone/Fax

Practice location:
  • Phone: 346-231-6830
  • Fax: 346-231-6835
Mailing address:
  • Phone: 346-231-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME164001
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberT7699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: