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General NPI Number Information
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NPI Number | 1407094873
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Entity Type | Individual
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Provider Name | MOLUK MIRRASOULI RAGLAND D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 7003 S NEW BRAUNFELS AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78223-4588
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Country | US
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Telephone | 678-501-2814
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2232
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N1423
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License Number State | TX
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