Provider Demographics
NPI:1679281497
Name:FATIMA, TABBASUM
Entity type:Individual
Prefix:
First Name:TABBASUM
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 SIERRA BLANCA DR APT 5201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7508
Mailing Address - Country:US
Mailing Address - Phone:346-775-2897
Mailing Address - Fax:
Practice Address - Street 1:6301 SIERRA BLANCA DR APT 5201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7508
Practice Address - Country:US
Practice Address - Phone:346-775-2897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2614836376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker