Provider Demographics
NPI:1114662319
Name:MUTHURAJU, SOWMIYA (RDN)
Entity type:Individual
Prefix:
First Name:SOWMIYA
Middle Name:
Last Name:MUTHURAJU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SOMI
Other - Middle Name:
Other - Last Name:MUTHURAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:6410 FANNIN ST STE UPB500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:832-352-7165
Mailing Address - Fax:713-486-0885
Practice Address - Street 1:6410 FANNIN ST STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3005
Practice Address - Country:US
Practice Address - Phone:832-352-6516
Practice Address - Fax:713-500-5750
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered