Provider Demographics
NPI:1871370387
Name:TAVAKOLI, AZARDOKHT
Entity type:Individual
Prefix:MRS
First Name:AZARDOKHT
Middle Name:
Last Name:TAVAKOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AZAR
Other - Middle Name:
Other - Last Name:TAVAKOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4511 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6709
Mailing Address - Country:US
Mailing Address - Phone:832-725-9751
Mailing Address - Fax:
Practice Address - Street 1:3100 TIMMONS LN STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5925
Practice Address - Country:US
Practice Address - Phone:832-983-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist