Provider Demographics
NPI:1841741907
Name:RAQUEL M SAGULLO, MD, PLLC
Entity Type:Organization
Organization Name:RAQUEL M SAGULLO, MD, PLLC
Other - Org Name:CINCO WEST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:MIA
Authorized Official - Last Name:SAGULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-221-7611
Mailing Address - Street 1:9006 S. FRY ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9006 S. FRY ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-221-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2278261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care