Provider Demographics
NPI:1659660991
Name:ZINN, ROSHANAK MANSOURI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:MANSOURI
Last Name:ZINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSHANAK
Other - Middle Name:
Other - Last Name:MANSOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:919 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2703
Mailing Address - Country:US
Mailing Address - Phone:512-544-4222
Mailing Address - Fax:
Practice Address - Street 1:919 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2703
Practice Address - Country:US
Practice Address - Phone:512-544-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10030828207V00000X
TXP3198207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303168407Medicaid
TX303168405Medicaid
TX303168407Medicaid
TX376751ZKQ5Medicare PIN