Provider Demographics
NPI:1346434750
Name:M.K. HAMZA PH.D., P.A.
Entity Type:Organization
Organization Name:M.K. HAMZA PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M.K.
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-729-0400
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:STE 110
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-729-0400
Mailing Address - Fax:409-729-0453
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:STE 110
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-729-0400
Practice Address - Fax:409-729-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33373103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185694001Medicaid
TX00Y027Medicare PIN