Provider Demographics
NPI:1962512343
Name:MOOSANI, AQUILLA B (MD)
Entity type:Individual
Prefix:
First Name:AQUILLA
Middle Name:B
Last Name:MOOSANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AQILA
Other - Middle Name:IQBAL
Other - Last Name:GODIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13750 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4375
Mailing Address - Country:US
Mailing Address - Phone:210-561-3100
Mailing Address - Fax:
Practice Address - Street 1:1204 SHANNON OAKS TRL STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7303
Practice Address - Country:US
Practice Address - Phone:512-585-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15958528172A00000X
TXJ9223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No172A00000XOther Service ProvidersDriverGroup - Single Specialty