Individual
LAILA KHAZAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M8762
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006495200
—
FL
01
—
14M7C
BLUE CROSS BLUE SHIELD
FL
05
—
401038101
—
TX
01
—
401038102
CSHCN
TX
01
—
G0036Z
MEDICARE PTAN
FL
Enumeration date
02/09/2007
Last updated
03/30/2022
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