Provider Demographics
NPI:1073738043
Name:SAIJARI, MOHAMAD M (LSA)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:M
Last Name:SAIJARI
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 RICHMOND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-7402
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:5090 RICHMOND AVE STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-7402
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00092363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00092OtherLICENSE SURGICAL ASSISTANT
TX00000072JROtherBLUE CROSS BLUE SHIELD