Provider Demographics
NPI:1982706016
Name:SAGULLO, RAQUEL MIA (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:MIA
Last Name:SAGULLO
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 1:9006 S FRY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7861
Mailing Address - Country:US
Mailing Address - Phone:281-665-3013
Mailing Address - Fax:
Practice Address - Street 1:9006 S FRY RD
Practice Address - Street 2:SUITE D
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7861
Practice Address - Country:US
Practice Address - Phone:281-665-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics