Provider Demographics
NPI:1518544774
Name:AVULA, POOJA
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:AVULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SILO RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7315
Mailing Address - Country:US
Mailing Address - Phone:708-269-9329
Mailing Address - Fax:
Practice Address - Street 1:152 SILO RIDGE RD N
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7315
Practice Address - Country:US
Practice Address - Phone:708-269-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program