Healthcare Provider Details

I. General information

NPI: 1780098152
Provider Name (Legal Business Name): SVETLANA RABINOVICH M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1720
HOUSTON TX
77030-2735
US

IV. Provider business mailing address

6560 FANNIN ST STE 1720
HOUSTON TX
77030-2735
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-0058
  • Fax:
Mailing address:
  • Phone: 713-790-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS4045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: