Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | J4466 | TX |
NPI | 1174607857 |
---|---|
Provider Name | Amir Rassoli |
First Address | Houston, TX 77205 |
Second Address | Baytown, TX 77521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 05/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138437208 | (05) | TX |
F75040 | (02) | TX |