Healthcare Provider Details

I. General information

NPI: 1033164413
Provider Name (Legal Business Name): HOUSHANG AMINIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 N TATUM BLVD #100
PHX AZ
85028-6072
US

IV. Provider business mailing address

11020 N TATUM BLVD #100
PHX AZ
85028-6072
US

V. Phone/Fax

Practice location:
  • Phone: 602-996-0654
  • Fax: 602-996-7932
Mailing address:
  • Phone: 602-996-0654
  • Fax: 602-996-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: