Healthcare Provider Details

I. General information

NPI: 1578853941
Provider Name (Legal Business Name): THOMAS BABATUNDE SOBANDE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WINDSWEPT DR
CEDAR HILL TX
75104-3121
US

IV. Provider business mailing address

821 WINDSWEPT DR
CEDAR HILL TX
75104-3121
US

V. Phone/Fax

Practice location:
  • Phone: 214-893-4932
  • Fax:
Mailing address:
  • Phone: 214-893-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number787787
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number787787
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number787787
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number787787
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: