Provider Demographics
NPI:1609815596
Name:ALI MOUSSAOUI MD PA
Entity Type:Organization
Organization Name:ALI MOUSSAOUI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-290-1722
Mailing Address - Street 1:PO BOX 58805
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8805
Mailing Address - Country:US
Mailing Address - Phone:832-290-1722
Mailing Address - Fax:844-413-3832
Practice Address - Street 1:3801 VISTA RD STE 320
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2139
Practice Address - Country:US
Practice Address - Phone:832-831-1840
Practice Address - Fax:832-831-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK41612084N0400X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00662XMedicare PIN