Provider Demographics
NPI:1609515279
Name:GHANI, SAROSH
Entity Type:Individual
Prefix:
First Name:SAROSH
Middle Name:
Last Name:GHANI
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 1:2103 COLINAS VERDAS RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2734
Mailing Address - Country:US
Mailing Address - Phone:512-538-9938
Mailing Address - Fax:
Practice Address - Street 1:2103 COLINAS VERDAS RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-2734
Practice Address - Country:US
Practice Address - Phone:512-538-9938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program