Provider Demographics
NPI:1851602072
Name:WESTWIND MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:WESTWIND MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-845-4600
Mailing Address - Street 1:6604 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2960
Mailing Address - Country:US
Mailing Address - Phone:915-845-4600
Mailing Address - Fax:915-845-4602
Practice Address - Street 1:6604 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2960
Practice Address - Country:US
Practice Address - Phone:915-845-4600
Practice Address - Fax:915-845-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0799OtherTEXAS MEDICAL LICENSE