=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952924276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PARISA KHOSRAVI DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2020
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16040 PARK VALLEY DR STE 100
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-218-1222
-----------------------------------------------------
Fax | 512-218-1393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16040 PARK VALLEY DR STE 100
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-218-1222
-----------------------------------------------------
Fax | 512-218-1393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | V0444
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------