Provider Demographics
NPI:1164547790
Name:GOMBERAWALLA, HARSHADALA M (MD)
Entity Type:Individual
Prefix:
First Name:HARSHADALA
Middle Name:M
Last Name:GOMBERAWALLA
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 1:323 HUNTERS TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6949
Mailing Address - Country:US
Mailing Address - Phone:713-480-5272
Mailing Address - Fax:713-682-3850
Practice Address - Street 1:2925 W T C JESTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-7061
Practice Address - Country:US
Practice Address - Phone:713-682-3825
Practice Address - Fax:713-682-3850
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1671261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care