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General NPI Number Information
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NPI Number | 1407265572
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Entity Type | Organization
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Legal Business Name | ARUNA MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 417 OAKBEND DR SUITE 100
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City | LEWISVILLE
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State | TX
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Zip | 75067-2338
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Country | US
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Telephone | 214-814-1914
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Fax |
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Provider Business Mailing Address
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Address Line | 10327 OFFSHORE DR
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City | IRVING
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State | TX
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Zip | 75063-5092
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Country | US
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Telephone | 214-226-0093
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ARUNA BODDU
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Credential | M.D
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Telephone | 214-226-0093
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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 | L7943
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License Number State | TX
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