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General NPI Number Information
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NPI Number | 1396916706
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Entity Type | Individual
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Provider Name | ELLY E. POURASEF AUD, CCC/A
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 908 TOWN AND COUNTRY BLVD. SUITE 120
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City | HOUSTON
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State | TX
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Zip | 77024-2208
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Country | US
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Telephone | 713-984-7562
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Fax | 866-961-3161
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Provider Business Mailing Address
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Address Line | 9071 SOUTH 1300 WEST SUITE 100
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City | WEST JORDAN
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State | UT
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Zip | 84088
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Country | US
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Telephone | 801-938-1117
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Fax | 801-938-2771
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 80074
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 80074
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License Number State | TX
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