Healthcare Provider Details

I. General information

NPI: 1265889422
Provider Name (Legal Business Name): KHUSHBU AGRAWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST SUITE MSB 3.151
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

6431 FANNIN ST SUITE MSB 3.151
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5800
  • Fax: 713-500-5805
Mailing address:
  • Phone: 713-500-5800
  • Fax: 713-500-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS0418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: