Healthcare Provider Details

I. General information

NPI: 1871978346
Provider Name (Legal Business Name): KHEIREDDINE DAOUDI LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18703 DUKE LAKE -DR
SPRING TX
77388
US

IV. Provider business mailing address

PO BOX 2207
SPRING TX
77383-2207
US

V. Phone/Fax

Practice location:
  • Phone: 713-518-2153
  • Fax: 832-478-9266
Mailing address:
  • Phone: 281-653-2924
  • Fax: 832-478-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: