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General NPI Number Information
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NPI Number | 1205496700
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Entity Type | Organization
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Legal Business Name | PRIME ASSISTANT SOLUTIONS LLC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 12121 WESTHEIMER RD STE 120
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City | HOUSTON
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State | TX
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Zip | 77077-6682
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Country | US
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Telephone | 832-277-4501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 540088
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City | HOUSTON
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State | TX
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Zip | 77254-0088
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Country | US
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Telephone | 713-850-1190
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MOHAMMAD ETMINAN
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Credential | MD
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Telephone | 832-562-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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