Healthcare Provider Details

I. General information

NPI: 1225109648
Provider Name (Legal Business Name): SAROSH SALEEMI M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6618 SITIO DEL RIO BLVD STE 101
AUSTIN TX
78730
US

IV. Provider business mailing address

6618 SITIO DEL RIO BLVD STE 101
AUSTIN TX
78730-1143
US

V. Phone/Fax

Practice location:
  • Phone: 512-795-7575
  • Fax: 855-307-9139
Mailing address:
  • Phone: 512-795-7575
  • Fax: 855-307-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberL4689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: