Provider Information for 1548583743
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BENITA AMIRMAZAHERI
Sex: Female
NPI: 1548583743
Last Updated: 2010-03-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1548583743 | ||||||||
| Enumeration Date | 2010-03-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 628 RAINTREE CIR COPPELL, TX 75019-5447 United States Phone: 214-295-7586 | Fax: | ||||||||
| Primary Practice Address | 874 ED HALL DR SUITE 102-103 KAUFMAN, TX 75142-1861 United States Phone: 972-932-9345 | Fax: | ||||||||
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