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General NPI Number Information
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NPI Number | 1982607586
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Entity Type | Individual
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Provider Name | GIRISH CHIYYARATH VALLABHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 6102 82ND ST SUITE 5
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City | LUBBOCK
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State | TX
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Zip | 79424-0802
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Country | US
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Telephone | 806-771-0077
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Fax | 806-771-3175
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Provider Business Mailing Address
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Address Line | PO BOX 93005
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City | LUBBOCK
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State | TX
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Zip | 79493-3005
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Country | US
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Telephone | 806-771-0077
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Fax | 806-771-3175
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | H6672
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License Number State | TX
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