Provider Demographics
NPI:1710395488
Name:NOWLAKHA, POOJA (DPM)
Entity Type:Individual
Prefix:MS
First Name:POOJA
Middle Name:
Last Name:NOWLAKHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 TOWN CENTER BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1464
Mailing Address - Country:US
Mailing Address - Phone:281-565-0738
Mailing Address - Fax:
Practice Address - Street 1:3511 TOWN CENTER BLVD S STE 101
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-565-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT36-2014213EP1101X, 213E00000X, 213ES0103X
TX2301213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT36- 2014OtherTEMPORARY STATE BOARD LICENSE