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General NPI Number Information
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NPI Number | 1982733762
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Entity Type | Individual
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Provider Name | SUSHMA PENMETSA M.B.B.S
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4024 BROOKHAVEN AVE
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City | PASADENA
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State | TX
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Zip | 77504-1902
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Country | US
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Telephone | 712-944-2324
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Fax |
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Provider Business Mailing Address
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Address Line | 15507 TURTLE OAK CT
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City | HOUSTON
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State | TX
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Zip | 77059-3133
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Country | US
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Telephone | 512-203-2746
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M4438
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License Number State | TX
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