Basic Information
| Provider Information | |||||||||
| NPI: | 1235872359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOUNDARARAJAN | ||||||||
| FirstName: | PRIYA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1132 PEACH TREE AVE APT 204 | ||||||||
| Address2: | |||||||||
| City: | TONTITOWN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727623087 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1102 BARCLAY ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782077161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2022 | ||||||||
| LastUpdateDate: | 04/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.