Provider Demographics
NPI:1154354587
Name:MALLELA, VIJAYA L (MD)
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:L
Last Name:MALLELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 ALDINE MAIL ROUTE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-5934
Mailing Address - Country:US
Mailing Address - Phone:281-985-7600
Mailing Address - Fax:281-985-7620
Practice Address - Street 1:4755 ALDINE MAIL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-5934
Practice Address - Country:US
Practice Address - Phone:281-985-7600
Practice Address - Fax:281-985-7607
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88Y325OtherBCBS
TX134643901OtherCSHCN
TX134643902Medicaid
TX88Y325Medicare PIN
TX88Y325OtherBCBS
TX134643901OtherCSHCN