Provider Demographics
NPI:1780394643
Name:MAHMOODPOUR SOUDJANI, YASSMIN
Entity type:Individual
Prefix:
First Name:YASSMIN
Middle Name:
Last Name:MAHMOODPOUR SOUDJANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 PINEROCK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3222
Mailing Address - Country:US
Mailing Address - Phone:832-758-7135
Mailing Address - Fax:
Practice Address - Street 1:19002 PARK ROW STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7060
Practice Address - Country:US
Practice Address - Phone:346-251-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant