Provider Demographics
NPI:1053324657
Name:MATHEW, VIMALA (RN)
Entity Type:Individual
Prefix:
First Name:VIMALA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 MARTINIQUE PASS
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4159
Mailing Address - Country:US
Mailing Address - Phone:281-277-6646
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE ,HOUSTON,TEXAS
Practice Address - Street 2:5807 MARTINIQUE PASS
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-277-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656974163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health