1174523872 NPI number — PEYMAN PAKZABAN MDPA

Table of content: PEYMAN PAKZABAN MDPA (NPI 1174523872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174523872 NPI number — PEYMAN PAKZABAN MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAKZABAN
Provider First Name:
PEYMAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MDPA
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:
1174523872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 VISTA RD STE 440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-941-0008
Provider Business Mailing Address Fax Number:
713-941-6262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 VISTA RD STE 440
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-941-0008
Provider Business Practice Location Address Fax Number:
713-941-6262
Provider Enumeration Date:
07/26/2005

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: 207T00000X , with the licence number:  H8305 , 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: 6425199 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1320205 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G17452 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 036295601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1320205 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5613188 . This is a "AETNA ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BL550 . This is a "BCBS ACCOUNT NUMBER AS OF 07/24/2008" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00621639 . This is a "RAILROAD MEDICARE PART B" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00U34T . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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