Provider Demographics
NPI:1750437703
Name:SAMIRA ROUHANI
Entity type:Organization
Organization Name:SAMIRA ROUHANI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROUHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-228-2224
Mailing Address - Street 1:973 N COOPER
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011
Mailing Address - Country:US
Mailing Address - Phone:817-303-0003
Mailing Address - Fax:817-303-0004
Practice Address - Street 1:973 N COOPER
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:817-303-0003
Practice Address - Fax:817-303-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0081069332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176691702Medicaid
TX5439900001Medicare NSC