MEDICARE: MR. ELIAHKIM MAZO MABUTE NP

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	163W00000X	Registered Nurse	977911	TX
2	363LF0000X	Family Nurse Practitioner	1232439	TX

General Provider Information

NPI Number	:	1548081474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELIAHKIM MAZO MABUTE NP

Provider Business Mailing Address
First Line	:	9779 FANNIN RAILWAY
Second Line	:	APT 1115
City	:	HOUSTON
State	:	TX
Zip	:	77045-2256
Country	:	US
Telephone Number	:	409-291-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	9779 FANNIN RAILWAY
Second Line	:	APT 1115
City	:	HOUSTON
State	:	TX
Zip	:	77045-2256
Country	:	US
Telephone Number	:	409-291-0002
Fax Number	:

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

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	05/07/2026

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