Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | Q1085 | TX |
N | 207NS0135X | Procedural Dermatology | Q1085 | TX |
NPI | 1437461258 |
---|---|
Provider Name | Dr. Brundha Balaraman |
First Address | Pearland, TX 77584-3922 |
Second Address | Sugar Land, TX 77478-4077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 12/07/2021 |