Basic Information
| Provider Information | |||||||||
| NPI: | 1770022279 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOOMRO | ||||||||
| FirstName: | KANZA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1643 NW 136 AVE | ||||||||
| Address2: | BLDG. H STE. 100 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232857 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3625 GREEN CREST DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770824056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815581166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS15728 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | T4680 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.