Provider Demographics
NPI:1356018907
Name:BASALAT, RAED
Entity Type:Individual
Prefix:
First Name:RAED
Middle Name:
Last Name:BASALAT
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:PO BOX 570964
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77257-0964
Mailing Address - Country:US
Mailing Address - Phone:832-807-0928
Mailing Address - Fax:
Practice Address - Street 1:2440 TEXAS PKWY STE 340F
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4073
Practice Address - Country:US
Practice Address - Phone:832-807-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport