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General NPI Number Information
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NPI Number | 1689629123
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Entity Type | Individual
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Provider Name | SITA M BOPPANA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 2460 N CENTRAL EXPY SUITE 101
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City | RICHARDSON
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State | TX
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Zip | 75080-2713
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Country | US
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Telephone | 972-644-1100
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Fax | 972-644-1107
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Provider Business Mailing Address
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Address Line | PO BOX 830066
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City | RICHARDSON
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State | TX
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Zip | 75083-0066
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Country | US
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Telephone | 972-644-1100
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Fax | 972-644-1107
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K3994
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License Number State | TX
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