Provider Demographics
NPI:1932162617
Name:RAGUTHU, MANJULA (MD)
Entity type:Individual
Prefix:DR
First Name:MANJULA
Middle Name:
Last Name:RAGUTHU
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:PO BOX 5386
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5386
Mailing Address - Country:US
Mailing Address - Phone:956-546-7530
Mailing Address - Fax:956-546-7531
Practice Address - Street 1:315 JOSE MARTI BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2868
Practice Address - Country:US
Practice Address - Phone:956-546-7530
Practice Address - Fax:956-546-7531
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM2025OtherPHYSICIAN LICENSE
TXH49900Medicare UPIN
TXM2025OtherPHYSICIAN LICENSE