Healthcare Provider Details

I. General information

NPI: 1881902948
Provider Name (Legal Business Name): MARINA HOSSEIN NEJAD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINA MAHDJOUBI FNP

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 15TH ST
AUSTIN TX
78701-1930
US

IV. Provider business mailing address

1601 RIO GRANDE ST SUITE 340
AUSTIN TX
78701-1137
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7036
  • Fax:
Mailing address:
  • Phone: 512-795-5500
  • Fax: 512-795-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number638707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: