Provider Demographics
NPI:1548423320
Name:VALLABHAJOSULA, SAILAJA (MD)
Entity Type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:VALLABHAJOSULA
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:PO BOX 8074
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-8074
Mailing Address - Country:US
Mailing Address - Phone:281-332-2626
Mailing Address - Fax:281-332-7272
Practice Address - Street 1:711 W BAY AREA BLVD STE 602
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4042
Practice Address - Country:US
Practice Address - Phone:281-332-2626
Practice Address - Fax:281-332-7272
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1603207R00000X
TXBP1-0032776390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08HY49401OtherBCBS OF TX
TX296539405Medicaid