=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598172900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. R BAHRANI CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 02/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6853 COIT RD #200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-618-6745
-----------------------------------------------------
Fax | 972-231-3148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6853 COIT RD #200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-5486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-618-6745
-----------------------------------------------------
Fax | 972-231-3148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | MRS. ROKSAREH FAIZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 972-616-6119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 9938
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------