Provider Demographics
NPI:1407047699
Name:MOONAT, HATEL RANA (DO)
Entity Type:Individual
Prefix:
First Name:HATEL
Middle Name:RANA
Last Name:MOONAT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:713-792-0608
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 87
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6620
Practice Address - Fax:713-732-0608
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216491502Medicaid
TX346021YKQHMedicare PIN