Provider Demographics
NPI:1356662092
Name:HAMRAIE, FARIVASH (LAC (ACUPUNCTURIST))
Entity Type:Individual
Prefix:MRS
First Name:FARIVASH
Middle Name:
Last Name:HAMRAIE
Suffix:
Gender:F
Credentials:LAC (ACUPUNCTURIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W ROSEDALE ST STE 408
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7408
Mailing Address - Country:US
Mailing Address - Phone:817-338-1919
Mailing Address - Fax:817-338-1919
Practice Address - Street 1:1550 W ROSEDALE ST STE 408
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7408
Practice Address - Country:US
Practice Address - Phone:817-338-1919
Practice Address - Fax:817-338-1919
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00879171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist