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General NPI Number Information
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NPI Number | 1134649221
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Entity Type | Organization
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Legal Business Name | PRESTIGIOUS MEDICAL CARE PA
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4821 SATURN RD STE 104
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City | GARLAND
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State | TX
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Zip | 75041-5955
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Country | US
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Telephone | 214-434-4257
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Fax |
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Provider Business Mailing Address
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Address Line | 4821 SATURN RD STE 104
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City | GARLAND
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State | TX
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Zip | 75041-5955
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | VINAY VASUDENAN NAIR
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Credential | MD
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Telephone | 214-434-4257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N1010
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License Number State | TX
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