Basic Information
| Provider Information | |||||||||
| NPI: | 1780883868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAGHRI | ||||||||
| FirstName: | SANAZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2529 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787045466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789500 | ||||||||
| FaxNumber: | 5129789558 | ||||||||
| Practice Location | |||||||||
| Address1: | 2529 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787045466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789500 | ||||||||
| FaxNumber: | 5129789558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 233263 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A95172 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q1599 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.