Provider Demographics
NPI:1710636113
Name:FVR MEDICAL GROUP OF TEXAS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:FVR MEDICAL GROUP OF TEXAS PROFESSIONAL ASSOCIATION
Other - Org Name:THE PILL CLUB MEDICAL GROUP PROFESSIONAL ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALZALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-285-6927
Mailing Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1560
Mailing Address - Country:US
Mailing Address - Phone:650-285-6927
Mailing Address - Fax:888-352-7383
Practice Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1560
Practice Address - Country:US
Practice Address - Phone:650-285-6927
Practice Address - Fax:888-352-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty