Provider Demographics
NPI:1902933534
Name:TIRANDAZ, HOUSHMAND JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOUSHMAND
Middle Name:JOHN
Last Name:TIRANDAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MARSHALL
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2224
Mailing Address - Country:US
Mailing Address - Phone:281-557-1414
Mailing Address - Fax:281-557-4242
Practice Address - Street 1:109 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2224
Practice Address - Country:US
Practice Address - Phone:281-557-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG87622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760342474OtherTAX ID
TX128228702Medicaid
TX00G60TMedicare PIN
TX128228702Medicaid