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General NPI Number Information
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NPI Number | 1588112080
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Entity Type | Organization
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Legal Business Name | PHOENIX PEDIATRIC ALLIANCE, PLLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 150 PINE FOREST DR # 702
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City | SHENANDOAH
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State | TX
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Zip | 77384-5302
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Country | US
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Telephone | 713-955-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 150 PINE FOREST DR # 702
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City | SHENANDOAH
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State | TX
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Zip | 77384-5302
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Country | US
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Telephone | 713-955-2343
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MANAF GHASSAN AHMAD
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Credential | MD
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Telephone | 251-767-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K2395
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License Number State | TX
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