Provider Demographics
NPI:1396151304
Name:JANDALI, BOCHRA (MD)
Entity type:Individual
Prefix:
First Name:BOCHRA
Middle Name:
Last Name:JANDALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3008
Mailing Address - Country:US
Mailing Address - Phone:713-486-3100
Mailing Address - Fax:713-512-2246
Practice Address - Street 1:6410 FANNIN ST STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3008
Practice Address - Country:US
Practice Address - Phone:713-500-6900
Practice Address - Fax:713-500-0580
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8019207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty