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General NPI Number Information
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NPI Number | 1346573789
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Entity Type | Individual
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Provider Name | MOHAMMAD REZA PAKRAY
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Gender | Male
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 738 RANDOLPH STREET
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City | CHARLESTON
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State | WV
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Zip | 25302
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Country | US
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Telephone | 304-205-7241
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Fax | 304-345-5441
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Provider Business Mailing Address
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Address Line | 738 RANDOLPH STREET
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City | CHARLESTON
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State | WV
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Zip | 25302
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Country | US
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Telephone | 304-205-7241
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Fax | 304-345-5441
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 22204886
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License Number State | WV
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