Provider Demographics
NPI:1922578194
Name:REZA ASSADOLLAH, DCNP, PLLC
Entity Type:Organization
Organization Name:REZA ASSADOLLAH, DCNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-205-4995
Mailing Address - Street 1:4601 OLD SHEPARD PL STE 404
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5277
Mailing Address - Country:US
Mailing Address - Phone:469-782-1888
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL STE 404
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5277
Practice Address - Country:US
Practice Address - Phone:469-782-1888
Practice Address - Fax:469-782-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX782677OtherNP LICENSE