Healthcare Provider Details

I. General information

NPI: 1659623387
Provider Name (Legal Business Name): MANAL YOUSEF TANTOUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 05/17/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ STE 405A
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1 BAYLOR PLZ STE 405A
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-5928
  • Fax: 718-579-4744
Mailing address:
  • Phone: 713-798-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ4701
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberQ4701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: