Healthcare Provider Details

I. General information

NPI: 1366727729
Provider Name (Legal Business Name): THE NAIDU CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E 4TH ST STE 300
ODESSA TX
79761-5100
US

IV. Provider business mailing address

5425 NEW ORLEANS DR
ODESSA TX
79762-4736
US

V. Phone/Fax

Practice location:
  • Phone: 432-337-4347
  • Fax:
Mailing address:
  • Phone: 432-362-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2010011351
License Number StateTX

VIII. Authorized Official

Name: DR. RAJA BAVIKATI NAIDU
Title or Position: DOCTOR
Credential: M.D.
Phone: 432-337-4347