Healthcare Provider Details

I. General information

NPI: 1447261839
Provider Name (Legal Business Name): SANDHYA-RANI MOKKALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROFESSIONAL PARK DR
WEBSTER TX
77598-4127
US

IV. Provider business mailing address

15522 CONIFER BAY CT
HOUSTON TX
77059-3186
US

V. Phone/Fax

Practice location:
  • Phone: 281-661-1031
  • Fax: 281-661-1032
Mailing address:
  • Phone: 832-423-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: