=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255340436
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABA RAZI-SYED M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 06/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 VETERANS MEMORIAL DR.
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76504-9976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-743-2448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9867 VALLEY RANCH PKWY W APT. 1127
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-951-2037
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | L8485
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------