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General NPI Number Information
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NPI Number | 1497384457
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Entity Type | Individual
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Provider Name | MOHAN MUVVALA DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 8232 LOUISIANA BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2429
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Country | US
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Telephone | 505-605-3286
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Fax | 505-439-7139
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Provider Business Mailing Address
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Address Line | 8206 LOUISIANA BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1738
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Country | US
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Telephone | 505-605-3286
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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 | DO2023-1034
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 58.031299
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License Number State | OH
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