Provider Demographics
NPI:1215311741
Name:AVULA, SRAVANI
Entity type:Individual
Prefix:
First Name:SRAVANI
Middle Name:
Last Name:AVULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W SUNSET RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1770
Mailing Address - Country:US
Mailing Address - Phone:210-640-1646
Mailing Address - Fax:210-640-1647
Practice Address - Street 1:430 W SUNSET RD STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1770
Practice Address - Country:US
Practice Address - Phone:210-640-1646
Practice Address - Fax:210-640-1647
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067278207R00000X
TXT0709207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX427666901Medicaid