1225037799 NPI number — MIRHASSAN FARIVAR-MOHSENI M.D.

Table of content: MIRHASSAN FARIVAR-MOHSENI M.D. (NPI 1225037799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225037799 NPI number — MIRHASSAN FARIVAR-MOHSENI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARIVAR-MOHSENI
Provider First Name:
MIRHASSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225037799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75011-8162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-587-8888
Provider Business Mailing Address Fax Number:
210-587-8889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 NAVARRO ST
Provider Second Line Business Practice Location Address:
SUITE 1033
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-587-8888
Provider Business Practice Location Address Fax Number:
210-587-8889
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  J3465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 173442802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com