Provider Demographics
NPI:1083802011
Name:MIRYALA, RAGINI (MD)
Entity Type:Individual
Prefix:
First Name:RAGINI
Middle Name:
Last Name:MIRYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E MEDICAL CENTER BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4377
Mailing Address - Country:US
Mailing Address - Phone:281-480-7832
Mailing Address - Fax:281-480-7504
Practice Address - Street 1:205 E MEDICAL CENTER BLVD
Practice Address - Street 2:STE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4377
Practice Address - Country:US
Practice Address - Phone:281-480-7832
Practice Address - Fax:281-480-7504
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6256Medicare PIN