Provider Demographics
NPI:1508616327
Name:MANIMEKALAI KRISHNAMURTHI, JAYA SURYA
Entity Type:Individual
Prefix:
First Name:JAYA SURYA
Middle Name:
Last Name:MANIMEKALAI KRISHNAMURTHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 MATLOCK ROAD, MEDICAL CITY ARLINGTON
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015
Mailing Address - Country:US
Mailing Address - Phone:817-983-3024
Mailing Address - Fax:
Practice Address - Street 1:3301 MATLOCK ROAD, MEDICAL CITY ARLINGTON
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-983-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program