Healthcare Provider Details

I. General information

NPI: 1851549059
Provider Name (Legal Business Name): NARENDRA CIVUNIGUNTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 MAIN ST # 11B.171
HOUSTON TX
77030-2348
US

IV. Provider business mailing address

6620 MAIN ST # 11B.171
HOUSTON TX
77030-2348
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-2222
  • Fax: 713-798-0111
Mailing address:
  • Phone: 713-798-2222
  • Fax: 713-798-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ1118
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ1118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: