MEDICARE: MOHAN MUVVALA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO2023-1034	NM
2	207Q00000X	Family Medicine Physician	58.031299	OH

General Provider Information

NPI Number	:	1497384457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAN MUVVALA DO

Provider Business Mailing Address
First Line	:	8206 LOUISIANA BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1738
Country	:	US
Telephone Number	:	505-605-3286
Fax Number	:

Provider Business Practice Location Address
First Line	:	8232 LOUISIANA BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2429
Country	:	US
Telephone Number	:	505-605-3286
Fax Number	:	505-439-7139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	09/03/2025

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Directions to “ MOHAN MUVVALA DO” Practice Location

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