Healthcare Provider Details

I. General information

NPI: 1912352337
Provider Name (Legal Business Name): ZHALEH JACQUELINE AMINI-VAUGHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 KUYKENDAHL RD STE D
SPRING TX
77382-2878
US

IV. Provider business mailing address

909 FROSTWOOD DR STE 1.100
HOUSTON TX
77024-2301
US

V. Phone/Fax

Practice location:
  • Phone: 713-897-7244
  • Fax:
Mailing address:
  • Phone: 713-338-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10057686
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4356
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: