Provider Demographics
NPI:1114692985
Name:VALIANTMD PLLC
Entity Type:Organization
Organization Name:VALIANTMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-999-6519
Mailing Address - Street 1:4806 RIVERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4092
Mailing Address - Country:US
Mailing Address - Phone:562-999-6519
Mailing Address - Fax:
Practice Address - Street 1:4806 RIVERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4092
Practice Address - Country:US
Practice Address - Phone:562-999-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty