Provider Demographics
NPI:1114662319
Name:MUTHURAJU, SOWMIYA (RDN)
Entity Type:Individual
Prefix:
First Name:SOWMIYA
Middle Name:
Last Name:MUTHURAJU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOLCOMBE BLVD OFC 1C-211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:409-338-9598
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD OFC 1C-211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered