Healthcare Provider Details

I. General information

NPI: 1801341201
Provider Name (Legal Business Name): MALVIKA GOYEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY KUTTY DOMINIC FNP

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 NASA PKWY
HOUSTON TX
77058-3039
US

IV. Provider business mailing address

2237 WAXWING DRIVE
LEAGUE CITY TX
77573
UM

V. Phone/Fax

Practice location:
  • Phone: 281-218-6777
  • Fax: 866-665-6208
Mailing address:
  • Phone: 832-629-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: