Healthcare Provider Details

I. General information

NPI: 1497163455
Provider Name (Legal Business Name): DR. CAROLINE MBATHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S 1ST ST
AUSTIN TX
78745-3108
US

IV. Provider business mailing address

5600 S 1ST ST
AUSTIN TX
78745-3108
US

V. Phone/Fax

Practice location:
  • Phone: 205-218-0673
  • Fax:
Mailing address:
  • Phone: 205-218-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number51240
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: