Healthcare Provider Details

I. General information

NPI: 1225269277
Provider Name (Legal Business Name): SOFIA ANSARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6537 PRESTON RD
PLANO TX
75024-2610
US

IV. Provider business mailing address

PO BOX 802772
DALLAS TX
75380
US

V. Phone/Fax

Practice location:
  • Phone: 972-484-7700
  • Fax: 972-484-7718
Mailing address:
  • Phone: 972-484-7700
  • Fax: 972-484-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberP9508
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: