Healthcare Provider Details

I. General information

NPI: 1295313666
Provider Name (Legal Business Name): ROUZBEH ROBERT KOTAKI MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ
HOUSTON TX
77030-3498
US

IV. Provider business mailing address

510 LOVETT BLVD APT 403
HOUSTON TX
77006-4092
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-5928
  • Fax:
Mailing address:
  • Phone: 956-369-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: