Healthcare Provider Details

I. General information

NPI: 1598106437
Provider Name (Legal Business Name): SOUMYA BILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE DEPT OF PEDIATRICS
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4800 ALBERTA AVE DEPT OF PEDIATRICS
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-8826
  • Fax: 915-545-6975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10047630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: