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General NPI Number Information
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NPI Number | 1326477142
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Entity Type | Organization
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Legal Business Name | AVECENNA EXPRESS HEALTH CARE
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 3315 REDSTONE DR
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City | ARLINGTON
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State | TX
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Zip | 76001-6505
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Country | US
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Telephone | 817-966-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 REDSTONE DR
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City | ARLINGTON
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State | TX
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Zip | 76001-6505
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Country | US
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Telephone | 817-966-6222
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. PARVANEH FIROZBAKHT
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Credential | PA-C
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Telephone | 817-966-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | PA03421
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License Number State | TX
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