Provider Demographics
NPI:1205805710
Name:GULFCOAST PAIN & REHABILITATION, P.A.
Entity type:Organization
Organization Name:GULFCOAST PAIN & REHABILITATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORIVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-252-9993
Mailing Address - Street 1:18838 S MEMORIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4279
Mailing Address - Country:US
Mailing Address - Phone:281-252-9993
Mailing Address - Fax:281-252-9997
Practice Address - Street 1:18838 S MEMORIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4279
Practice Address - Country:US
Practice Address - Phone:281-252-9993
Practice Address - Fax:281-252-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00888NMedicare ID - Type Unspecified