Provider Demographics
NPI:1548747249
Name:HOSHIDARI, ROSHANAK
Entity Type:Individual
Prefix:
First Name:ROSHANAK
Middle Name:
Last Name:HOSHIDARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 S FRY RD APT 418
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7307
Mailing Address - Country:US
Mailing Address - Phone:337-371-7686
Mailing Address - Fax:
Practice Address - Street 1:3306 S FRY RD APT 418
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7307
Practice Address - Country:US
Practice Address - Phone:337-371-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331641164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse