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General NPI Number Information
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NPI Number | 1093072142
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Entity Type | Individual
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Provider Name | AZADEH NAMIRANIAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 8230 WALNUT HILL LN SUITE 610
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City | DALLAS
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State | TX
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Zip | 75231-4482
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Country | US
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Telephone | 214-345-7398
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Fax | 214-345-4264
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Provider Business Mailing Address
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Address Line | PO BOX 35629
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City | DALLAS
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State | TX
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Zip | 75235-0629
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Country | US
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Telephone | 214-424-2213
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Fax | 214-231-2159
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA22234
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA22234
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA07659
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA07659
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License Number State | TX
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