Provider Demographics
NPI:1073190021
Name:RATHOD, AISHWARYAKUNVERBA (DO)
Entity Type:Individual
Prefix:
First Name:AISHWARYAKUNVERBA
Middle Name:
Last Name:RATHOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AISHWARYA
Other - Middle Name:
Other - Last Name:RATHOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2401 S 31ST ST # MS -M2663
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:254-771-8411
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST # MS -M2663
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-771-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU2991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine