Healthcare Provider Details

I. General information

NPI: 1326122847
Provider Name (Legal Business Name): ALIREZA EFTEKHARI MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 N GALLOWAY AVE SUITE 301-A
MESQUITE TX
75150-4814
US

IV. Provider business mailing address

PO BOX 550372
DALLAS TX
75355-0372
US

V. Phone/Fax

Practice location:
  • Phone: 972-613-3440
  • Fax:
Mailing address:
  • Phone: 214-348-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: