Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | N4502 | TX |
NPI | 1003002627 |
---|---|
Provider Name | Dr. Samatha Krishna Kadiyala |
First Address | Lake Jackson, TX 77566-5617 |
Second Address | Lake Jackson, TX 77566-5128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 06/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206442001 | (05) | TX |
8L20445 | (02) | TX |