Provider Demographics
NPI:1740567015
Name:VEJOVIS HEALTH
Entity Type:Organization
Organization Name:VEJOVIS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAMMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIAKKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-761-0125
Mailing Address - Street 1:7301 RANCH RD 620 N
Mailing Address - Street 2:STE 155 293
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4539
Mailing Address - Country:US
Mailing Address - Phone:512-761-0125
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-3213
Practice Address - Country:US
Practice Address - Phone:210-832-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty