MEDICARE: SAMINA HABIB TAHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	200200291	NC
2	208000000X	Pediatrics Physician	C54837	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200200291	OTHER	NC	NC LICENSE #
2	C54837	OTHER	CA	CA LICENSE #

General Provider Information

NPI Number	:	1073510533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMINA HABIB TAHA M.D.

Provider Business Mailing Address
First Line	:	24342 BAXTER DR
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4742
Country	:	US
Telephone Number	:	310-804-4013
Fax Number	:

Provider Business Practice Location Address
First Line	:	24342 BAXTER DR
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4742
Country	:	US
Telephone Number	:	310-804-4013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/15/2024

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