=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942712138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CARE USA, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2017
-----------------------------------------------------
Last Update Date | 10/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 NORTHSTAR RD
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75082-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-952-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4927 CRUZ BAY DR
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28110-7665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-952-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | HINA ZAMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-952-0504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | Q9927
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------