Healthcare Provider Details

I. General information

NPI: 1083802011
Provider Name (Legal Business Name): RAGINI MIRYALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MEDICAL CENTER BLVD STE B
WEBSTER TX
77598-4377
US

IV. Provider business mailing address

205 E MEDICAL CENTER BLVD STE B
WEBSTER TX
77598-4377
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-7832
  • Fax: 281-480-7504
Mailing address:
  • Phone: 281-480-7832
  • Fax: 281-480-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: