Provider Demographics
NPI:1962939637
Name:NAYAK, REETHU KUMBLA (MD)
Entity type:Individual
Prefix:
First Name:REETHU
Middle Name:KUMBLA
Last Name:NAYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUMBLA
Other - Middle Name:REETHU
Other - Last Name:NAYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1739 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1639
Mailing Address - Country:US
Mailing Address - Phone:210-491-8179
Mailing Address - Fax:210-590-2664
Practice Address - Street 1:1739 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1639
Practice Address - Country:US
Practice Address - Phone:210-491-8179
Practice Address - Fax:210-590-2664
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10059403390200000X
TXS8471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program