Individual
JACOB T KURUVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06597
TX
363AM0700X
Medical Physician Assistant
PA06597
TX
363AS0400X
Surgical Physician Assistant
013727-1
NY
363AS0400X
Surgical Physician Assistant
PA06597
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214721706
—
TX
Enumeration date
12/03/2009
Last updated
03/17/2018
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