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NPI Code Detail

MEDICARE: PAULINA THANAWALA D.O.

MEDICARE: PAULINA THANAWALA D.O.
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
1207Q00000XFamily Medicine PhysicianR7613TX
2390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740669746
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINA THANAWALA D.O.
Provider Business Mailing Address
First Line : 4001 W 15TH ST STE 245
Second Line :
City : PLANO
State : TX
Zip : 75093-5839
Country : US
Telephone Number : 972-596-5222
Fax Number : 972-596-5291
Provider Business Practice Location Address
First Line : 4001 W 15TH ST STE 245
Second Line :
City : PLANO
State : TX
Zip : 75093-5839
Country : US
Telephone Number : 972-596-5222
Fax Number : 972-596-5291
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2015
Last Update Date : 07/29/2021

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1194283895 — NOEL TRUONG PEARSON NP
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Directions to “ PAULINA THANAWALA D.O.” Practice Location

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