Provider Demographics
NPI:1144391996
Name:AMINZADEH, ABDOLRHIM MOHAMAD (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:ABDOLRHIM
Middle Name:MOHAMAD
Last Name:AMINZADEH
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W BAR LE DOC DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6248
Mailing Address - Country:US
Mailing Address - Phone:361-992-2048
Mailing Address - Fax:
Practice Address - Street 1:6500 S PADRE ISLAND DR STE 18
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4055
Practice Address - Country:US
Practice Address - Phone:361-992-2048
Practice Address - Fax:361-992-2094
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAC00183OtherLICENSE NUMBER