Healthcare Provider Details

I. General information

NPI: 1912429309
Provider Name (Legal Business Name): RUMAISA ALTAYIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 HOFFNER AVE
ORLANDO FL
32812-2331
US

IV. Provider business mailing address

1624 CARIBOU HUNT TRL
ORLANDO FL
32824-5670
US

V. Phone/Fax

Practice location:
  • Phone: 407-218-4744
  • Fax:
Mailing address:
  • Phone: 734-239-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12012804A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022278
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN24683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: