Provider Demographics
NPI:1669472205
Name:FARIDA VALLIANI MD P A
Entity Type:Organization
Organization Name:FARIDA VALLIANI MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:FARRUKH
Authorized Official - Last Name:VALLIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-731-0031
Mailing Address - Street 1:3740 N JOSEY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:214-731-0031
Mailing Address - Fax:214-731-0065
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:214-731-0031
Practice Address - Fax:214-731-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157962501Medicaid
TX00165VMedicare PIN