Healthcare Provider Details

I. General information

NPI: 1790865038
Provider Name (Legal Business Name): HOMEIRA IZADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/21/2009
Certification Date: IZADI HOMEIRA 1401 GARCES HWY DELANO CA 93215 6621 FANNIN ST HOUSTON TX 77030
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

1401 GARCES HWY PO BOX 460
DELANO CA
93215-3690
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-1380
  • Fax: 832-825-2799
Mailing address:
  • Phone: 210-586-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics
License NumberM0067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: