Individual
AZADEH NAMIRANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8230 WALNUT HILL LN, SUITE 610, DALLAS, TX 75231-4482
(214) 345-7398
(214) 345-4264
Mailing address
PO BOX 35629, DALLAS, TX 75235-0629
(214) 424-2213
(214) 231-2159
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA07659
TX
363AM0700X
Medical Physician Assistant
Primary
PA22234
CA
363AS0400X
Surgical Physician Assistant
PA07659
TX
363AS0400X
Surgical Physician Assistant
PA22234
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270096920
TAX ID
CA
05
—
GR0102820
—
CA
Enumeration date
04/13/2012
Last updated
09/16/2014
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