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General NPI Number Information
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NPI Number | 1417362724
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Entity Type | Organization
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Legal Business Name | ADCCTX
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 4605 N 35 HWY
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City | AUSTIN
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State | TX
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Zip | 78722
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Country | US
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Telephone | 512-287-9725
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 N HWY 35
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City | AUSTIN
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State | TX
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Zip | 78722
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Country | US
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Telephone | 512-287-9725
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | SHAYAN MAJIDI
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Credential | MBA
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Telephone | 512-287-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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