Provider Demographics
NPI:1336669910
Name:ESMAEILI, NADIA (PA)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:ESMAEILI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4568
Mailing Address - Country:US
Mailing Address - Phone:281-771-1166
Mailing Address - Fax:281-771-1168
Practice Address - Street 1:1463 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4568
Practice Address - Country:US
Practice Address - Phone:281-771-1166
Practice Address - Fax:281-771-1168
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant