=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851378749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUAZI PARVIN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2005
-----------------------------------------------------
Last Update Date | 04/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3676 PARKER BLVD SUITE# 260
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81008-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-553-2204
-----------------------------------------------------
Fax | 719-553-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5402 PEREGRINE DR
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81005-5538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 43488
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------