Healthcare Provider Details

I. General information

NPI: 1568624682
Provider Name (Legal Business Name): RAVI K SOMAYAZULA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 KATY FWY SUITE 520
HOUSTON TX
77055-7469
US

IV. Provider business mailing address

9230 KATY FWY SUITE 520
HOUSTON TX
77055-7469
US

V. Phone/Fax

Practice location:
  • Phone: 281-242-1061
  • Fax: 832-939-8420
Mailing address:
  • Phone: 281-242-1061
  • Fax: 832-939-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number218605
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberP1023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: