Individual
DR. MAYA S PATHIKONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 E AIRLINE RD, VICTORIA, TX 77901-3926
(361) 575-8500
(361) 575-8416
Mailing address
601 E AIRLINE RD, VICTORIA, TX 77901-3926
(361) 575-8500
(361) 575-8416
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J8082
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039AZ
GROUP BCBS
TX
05
—
079684901
—
TX
05
—
079684902
—
TX
05
—
118369103
—
TX
01
—
742777132
TAX ID
TX
01
—
88070B
INDIVIDUAL BCBS
TX
Enumeration date
06/09/2006
Last updated
04/01/2010
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