Organization
COMPREHENSIVE CARDIAC CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUBRAMANYA VARA PRASAD GAJARAJU VENKATA MD (OWNER)
(936) 639-0988
Entity
Organization
Contact information
Practice address
710 GASLIGHT BLVD, LUFKIN, TX 75904
(936) 639-0988
Mailing address
710 GASLIGHT BLVD, LUFKIN, TX 75904
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3806259-01
—
TX
Enumeration date
12/03/2018
Last updated
03/16/2021
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