Provider Demographics
NPI:1780248674
Name:ALTARAZI, KHOLOUD YASER (MBBS)
Entity type:Individual
Prefix:
First Name:KHOLOUD
Middle Name:YASER
Last Name:ALTARAZI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15818 PARKER ST # NE68118
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2356
Mailing Address - Country:US
Mailing Address - Phone:405-885-9163
Mailing Address - Fax:
Practice Address - Street 1:15818 PARKER ST # NE68118
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2356
Practice Address - Country:US
Practice Address - Phone:405-885-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP88412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty