Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | J3165 | TX |
N | 111NI0900X | Internist | J3165 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | J3165 | TX |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | J3165 | TX |
N | 207RI0011X | Interventional Cardiology | J3165 | TX |
NPI | 1295821478 |
---|---|
Provider Name | Ali Mortazavi |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77025-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117188603 | (05) | TX |
117188607 | (05) | TX |
117188608 | (05) | TX |