Healthcare Provider Details

I. General information

NPI: 1194256396
Provider Name (Legal Business Name): SALLY ZIATABAR D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 281-484-9369
  • Fax:
Mailing address:
  • Phone: 832-715-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU3065
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberU3065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: