Provider Demographics
NPI:1780174268
Name:PULIVARTHI, SWAROOPA
Entity type:Individual
Prefix:
First Name:SWAROOPA
Middle Name:
Last Name:PULIVARTHI
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 1:27700 NORTHWEST FWY STE 360
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8028
Mailing Address - Country:US
Mailing Address - Phone:346-231-6830
Mailing Address - Fax:
Practice Address - Street 1:27700 NORTHWEST FWY STE 360
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8028
Practice Address - Country:US
Practice Address - Phone:346-231-6830
Practice Address - Fax:346-231-6835
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1640012084N0400X
WV390200000X
TXT76992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program