=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194757534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJIV LAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 01/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21212 NORTH WEST FREEWAY 355
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-890-9944
-----------------------------------------------------
Fax | 281-890-9955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 PARK GROVE LN SUITE 310
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-464-9100
-----------------------------------------------------
Fax | 713-468-6183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | M3288
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | M3288
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------