Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | P5871 | TX |
NPI | 1023314739 |
---|---|
Provider Name | Neena M. Penagaluru |
First Address | San Antonio, TX 78216-6256 |
Second Address | New Braunfels, TX 78130-3585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2011 |
Last Update Date | 14/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
328588401 | (05) | TX |
P01258507 | MEDICARE RAIL ROAD (01) | TX |