Provider Demographics
NPI:1053432161
Name:TABBAKH, MARIA LUZ (MSN, CNS-BC)
Entity type:Individual
Prefix:MRS
First Name:MARIA LUZ
Middle Name:
Last Name:TABBAKH
Suffix:
Gender:F
Credentials:MSN, CNS-BC
Other - Prefix:MRS
Other - First Name:MARIA LUZ
Other - Middle Name:
Other - Last Name:ITCHON-TABBAKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,, CNP
Mailing Address - Street 1:545 MOORLAND DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1182
Mailing Address - Country:US
Mailing Address - Phone:313-469-7418
Mailing Address - Fax:
Practice Address - Street 1:20050 HARVARD AVE STE 207
Practice Address - Street 2:CLEVELAND CLINIC PAIN MANAGEMENT
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6800
Practice Address - Country:US
Practice Address - Phone:313-516-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15835-NS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP92884Medicare UPIN