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General NPI Number Information
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NPI Number | 1619170438
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Entity Type | Individual
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Provider Name | VENKATA KRISHNA PUPPALA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4402
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Country | US
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Telephone | 210-358-2712
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Fax | 210-358-2802
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Provider Business Mailing Address
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Address Line | 903 W MARTIN ST # MS 49-2
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City | SAN ANTONIO
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State | TX
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Zip | 78207-0903
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Country | US
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Telephone | 210-358-5909
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Fax | 210-358-5940
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 48505
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | V3413
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License Number State | TX
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