Healthcare Provider Details

I. General information

NPI: 1780976217
Provider Name (Legal Business Name): MEHRDAD SALAMAT MD.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 SARATOGA BLVD 320
CORPUS CHRISTI TX
78414-4252
US

IV. Provider business mailing address

5802 SARATOGA BLVD 320
CORPUS CHRISTI TX
78414-4252
US

V. Phone/Fax

Practice location:
  • Phone: 361-452-4404
  • Fax: 361-452-4407
Mailing address:
  • Phone: 361-452-4404
  • Fax: 361-452-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL1728
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberL1728
License Number StateTX

VIII. Authorized Official

Name: DR. MEHRDAD SALAMAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 361-452-4404