Healthcare Provider Details

I. General information

NPI: 1720665946
Provider Name (Legal Business Name): HUMERA TABASSUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S AVENUE B BLDG 20
YUMA AZ
85364-7726
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 923-336-2434
  • Fax:
Mailing address:
  • Phone: 928-336-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number79818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: