MEDICARE: DR. GIOVANNA GHAFOORI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	K5955	TX

General Provider Information

NPI Number	:	1043211162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIOVANNA GHAFOORI MD

Provider Business Mailing Address
First Line	:	1649 SAM HOUSTON ST
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 SAM HOUSTON ST
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8124
Country	:	US
Telephone Number	:	956-428-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/24/2007

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