Healthcare Provider Details

I. General information

NPI: 1295094712
Provider Name (Legal Business Name): KHANYA FLOR MANATRAKOOL CUALOPING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST STOP 8143
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

1919 ALAMEDA DE LAS PULGAS APT 80
SAN MATEO CA
94403-1266
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2757
  • Fax:
Mailing address:
  • Phone: 650-312-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number566030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: