Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 17287 | TX |
NPI | 1063997526 |
---|---|
Provider Name | Anahita Mortazavi |
First Address | Katy, TX 77494-6736 |
Second Address | Houston, TX 77054-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |