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General NPI Number Information
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NPI Number | 1992165591
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Entity Type | Organization
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Legal Business Name | ALINEJAD WELLNESS,INC
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 1066 ROCHEL DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-3889
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Country | US
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Telephone | 240-304-9309
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Fax |
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Provider Business Mailing Address
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Address Line | 1066 ROCHEL DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-3889
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Country | US
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Telephone | 240-304-9309
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. NIMA A ALINEJAD
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Credential |
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Telephone | 240-304-9309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 204919
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License Number State | LA
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