=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356052369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOUSHIN EMAMI PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2022
-----------------------------------------------------
Last Update Date | 05/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16928 W BELL RD STE 701
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-8948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-850-0026
-----------------------------------------------------
Fax | 623-850-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16928 W BELL RD STE 701
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-8948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-850-0026
-----------------------------------------------------
Fax | 623-850-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 10017
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------