Healthcare Provider Details

I. General information

NPI: 1720196983
Provider Name (Legal Business Name): DUSARA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 W WALNUT HILL LN STE 100
IRVING TX
75038-3027
US

IV. Provider business mailing address

1329 W WALNUT HILL LN STE 100
IRVING TX
75038-3027
US

V. Phone/Fax

Practice location:
  • Phone: 972-228-1820
  • Fax: 972-572-1112
Mailing address:
  • Phone: 972-228-1820
  • Fax: 972-572-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1000937
License Number StateTX

VIII. Authorized Official

Name: MR. RAJESH B AMIN
Title or Position: VP OF OPERATIONS
Credential:
Phone: 972-228-1820