Provider Demographics
NPI:1437719754
Name:BLUE ZONE PRECISION HEALTH MEDICAL - PORT ARTHUR, PLLC
Entity Type:Organization
Organization Name:BLUE ZONE PRECISION HEALTH MEDICAL - PORT ARTHUR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:R
Authorized Official - Last Name:JALALI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-745-4421
Mailing Address - Street 1:701 N POST OAK RD STE 512
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3962
Mailing Address - Country:US
Mailing Address - Phone:713-927-4296
Mailing Address - Fax:
Practice Address - Street 1:3820 HIGHWAY 365 STE 500
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7569
Practice Address - Country:US
Practice Address - Phone:713-493-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center