Provider Demographics
NPI:1750736781
Name:POONAWALA, FARAH AMLANI (DO)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:AMLANI
Last Name:POONAWALA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:AMLANI
Other - Last Name:POONAWALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 73105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3105
Mailing Address - Country:US
Mailing Address - Phone:281-890-6800
Mailing Address - Fax:281-890-6865
Practice Address - Street 1:13311 HARGRAVE RD STE 120B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4559
Practice Address - Country:US
Practice Address - Phone:281-890-6800
Practice Address - Fax:281-890-6865
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056552208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics