Healthcare Provider Details

I. General information

NPI: 1881642940
Provider Name (Legal Business Name): FARNOUSH F. FAEZ-REZVANI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W. GRAND PKWY. S. G-120
KATY TX
77494-8300
US

IV. Provider business mailing address

1450 W. GRAND PKWY. S. G-120
KATY TX
77494-8300
US

V. Phone/Fax

Practice location:
  • Phone: 866-950-3627
  • Fax: 800-652-8206
Mailing address:
  • Phone: 866-950-3627
  • Fax: 800-652-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: