MEDICARE: REZA ASSADOLLAH, DCNP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	782677	OTHER	TX	NP LICENSE

General Provider Information

NPI Number	:	1922578194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REZA ASSADOLLAH, DCNP, PLLC

Provider Business Mailing Address
First Line	:	6380 LBJ FWY # 290
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6416
Country	:	US
Telephone Number	:	972-991-1153
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 LBJ FWY # 290
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6416
Country	:	US
Telephone Number	:	972-991-1153
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELLE MARCHESE
Credential	:
Telephone Number	:	214-205-4995

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	01/27/2026

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