Provider Demographics
NPI:1801341201
Name:GOYEL, MALVIKA
Entity type:Individual
Prefix:
First Name:MALVIKA
Middle Name:
Last Name:GOYEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KUTTY
Other - Last Name:DOMINIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2237 WAXWING DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:UM
Mailing Address - Phone:832-629-0956
Mailing Address - Fax:
Practice Address - Street 1:985 NASA PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3039
Practice Address - Country:US
Practice Address - Phone:281-218-6777
Practice Address - Fax:866-665-6208
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily