Provider Demographics
NPI:1255386058
Name:ABOUJAMOUS, RIAD ALI (NP)
Entity type:Individual
Prefix:MR
First Name:RIAD
Middle Name:ALI
Last Name:ABOUJAMOUS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 N CLOSNER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-7162
Mailing Address - Country:US
Mailing Address - Phone:956-383-8300
Mailing Address - Fax:956-383-3006
Practice Address - Street 1:3002 N CLOSNER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-7162
Practice Address - Country:US
Practice Address - Phone:956-383-8300
Practice Address - Fax:956-383-3006
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9215OtherBCBS
TX157749602Medicaid
TX647801OtherSTATE LISCENSE NUMBER
TXP00312692OtherRAIL ROAD MEDICARE
TXP00312692OtherRAIL ROAD MEDICARE
TX8N9215OtherBCBS