Provider Demographics
NPI:1124395025
Name:MAHUWALA, UMMAL B (PA-C)
Entity Type:Individual
Prefix:
First Name:UMMAL
Middle Name:B
Last Name:MAHUWALA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 E RED BIRD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-2008
Mailing Address - Country:US
Mailing Address - Phone:214-374-0827
Mailing Address - Fax:214-374-0927
Practice Address - Street 1:1251 E RED BIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-2008
Practice Address - Country:US
Practice Address - Phone:214-374-0827
Practice Address - Fax:214-374-0927
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06509133V00000X
TXPA07548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered