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General NPI Number Information
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NPI Number | 1588498604
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Entity Type | Organization
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Legal Business Name | SUNTI SRIVATHANAKUL MD PLLC
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Dates
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Enumeration Date | 08/30/2024
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 21651
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 833-536-7284
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Fax |
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Provider Business Mailing Address
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Address Line | 904 LAHINCH CIR
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City | RICHARDSON
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State | TX
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Zip | 75081-5140
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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 | OWNER
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Name | SUNTI SRIVATHANAKUL
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Credential | MD
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Telephone | 972-365-3023
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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 |
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License Number State |
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