Provider Demographics
NPI:1942582077
Name:BHALALA, REENA UTPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:UTPAL
Last Name:BHALALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REENA
Other - Middle Name:ROHITKUMAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5804 S OSO PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6323
Mailing Address - Country:US
Mailing Address - Phone:361-884-2242
Mailing Address - Fax:
Practice Address - Street 1:5542 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-653-5640
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ78740207V00000X, 207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD070060600Medicaid
TX488560YMR2Medicare Oscar/Certification
MD319225ZAEDMedicare PIN