Provider Demographics
NPI:1164118030
Name:DEHBOZORGI, HOOYA ALI
Entity Type:Individual
Prefix:
First Name:HOOYA
Middle Name:ALI
Last Name:DEHBOZORGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 W PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6215
Mailing Address - Country:US
Mailing Address - Phone:972-781-1795
Mailing Address - Fax:
Practice Address - Street 1:6301 W PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6215
Practice Address - Country:US
Practice Address - Phone:972-781-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician