Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | J4902 | TX |
N | 207VG0400X | Gynecologist | J4902 | TX |
NPI | 1588666879 |
---|---|
Provider Name | Rakesh Mangal |
First Address | Houston, TX 77054-2949 |
Second Address | Houston, TX 77054-2934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83055G | BLUE CROSS & BLUE SHIELD (01) | TX |
F82372 | (02) | TX |