| Dr. Shirin M. Bazaz, Llc | |
|
1600 W 38th St Suite 420 Austin TX 78731-6400 | |
| (512) 636-1704 | |
| (512) 374-4901 |
| Full Name | Dr. Shirin M. Bazaz, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1600 W 38th St, Austin, Texas |
| Authorized Official Name and Position | Shirin M Bazaz (PRESIDENT) |
| Authorized Official Contact | 5126361704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Shirin M. Bazaz, Llc 1600 W 38th St Suite 420 Austin TX 78731-6400 Ph: (512) 636-1704 | Dr. Shirin M. Bazaz, Llc 1600 W 38th St Suite 420 Austin TX 78731-6400 Ph: (512) 636-1704 |
| NPI Number | 1114251493 |
|---|---|
| Provider Enumeration Date | 09/20/2009 |
| Last Update Date | 09/20/2009 |
| Medicare PECOS PAC ID | 1456649896 |
|---|---|
| Medicare Enrollment ID | O20161018000705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114251493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 33557 (Texas) | Primary |
| Provider Name | Shirin M Bazaz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861529943 PECOS PAC ID: 4688836174 Enrollment ID: I20120430000147 |
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