1356820245 NPI number — EMERALD HEALTH PROFESSIONALS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356820245 NPI number — EMERALD HEALTH PROFESSIONALS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD HEALTH PROFESSIONALS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1356820245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 LAVACA ST STE 1401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11855 LEBANON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-8225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-764-6950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
YAZDANI
Authorized Official First Name:
REHAN
Authorized Official Middle Name:
SAEED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-620-0132

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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