Provider Demographics
NPI:1770374456
Name:ALIZADEH, KHOSROW
Entity type:Individual
Prefix:
First Name:KHOSROW
Middle Name:
Last Name:ALIZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-7005
Mailing Address - Country:US
Mailing Address - Phone:210-422-1238
Mailing Address - Fax:
Practice Address - Street 1:9 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-7005
Practice Address - Country:US
Practice Address - Phone:210-422-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20250634267344600000X
TX801018982344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi