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General NPI Number Information
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NPI Number | 1083724256
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Entity Type | Individual
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Provider Name | DJILLALI BOUDJENAH MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 4425 PLANO PKWY STE 1401
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City | CARROLLTON
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State | TX
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Zip | 75010-5036
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Country | US
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Telephone | 214-888-7711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 867443
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City | PLANO
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State | TX
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Zip | 75086-7443
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Country | US
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Telephone | 214-888-7711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CS00211459
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License Number State | NM
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