Provider Demographics
NPI:1073967626
Name:KURIAKOSE, MAYA ALEX (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:ALEX
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:SARA
Other - Last Name:ALEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 N. WALDROP
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-591-2715
Mailing Address - Fax:
Practice Address - Street 1:1001 N. WALDROP
Practice Address - Street 2:SUITE 505
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-591-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology