Healthcare Provider Details

I. General information

NPI: 1104823483
Provider Name (Legal Business Name): SRINIVASACHARI VATSALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1840
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

6560 FANNIN ST STE 1840, SCURLOCK TOWER
HOUSTON TX
77030-2761
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-2050
  • Fax: 713-799-2951
Mailing address:
  • Phone: 713-799-2050
  • Fax: 713-799-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF6148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: