Provider Demographics
NPI:1598172900
Name:DR. R BAHRANI CLINIC PA
Entity Type:Organization
Organization Name:DR. R BAHRANI CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROKSAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-616-6119
Mailing Address - Street 1:6853 COIT RD
Mailing Address - Street 2:#200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5486
Mailing Address - Country:US
Mailing Address - Phone:972-618-6745
Mailing Address - Fax:972-231-3148
Practice Address - Street 1:6853 COIT RD
Practice Address - Street 2:#200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-618-6745
Practice Address - Fax:972-231-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9938261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center