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General NPI Number Information
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NPI Number | 1164710570
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Entity Type | Organization
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Legal Business Name | PREMA L. VINDHYA, M.D., P. A.
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 2479 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4232
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Country | US
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Telephone | 432-333-1901
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Fax | 432-520-5914
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Provider Business Mailing Address
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Address Line | 2479 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4232
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Country | US
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Telephone | 432-333-1901
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Fax | 432-520-5914
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Authorized Official
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Title or Position | OWNER
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Name | DR. PREMALATHA VINDHYA
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Credential | MD
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Telephone | 432-333-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G7739
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License Number State | TX
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