MEDICARE: DR. RIAZ S MAZCURI M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	G9772	TX
2	2084P0800X	Psychiatry Physician	G9772	TX
3	2084P0805X	Geriatric Psychiatry Physician	G9772	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801885306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIAZ S MAZCURI M.D.

Provider Business Mailing Address
First Line	:	6420 HILLCROFT ST
Second Line	:	STE 403
City	:	HOUSTON
State	:	TX
Zip	:	77081-3103
Country	:	US
Telephone Number	:	713-773-4505
Fax Number	:	832-436-1669

Provider Business Practice Location Address
First Line	:	6420 HILLCROFT ST
Second Line	:	STE 403
City	:	HOUSTON
State	:	TX
Zip	:	77081-3103
Country	:	US
Telephone Number	:	713-773-4505
Fax Number	:	713-773-3591

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	06/14/2016

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