Healthcare Provider Details

I. General information

NPI: 1437889961
Provider Name (Legal Business Name): DR. MAMOON BARBANDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 RICHMOND AVE STE 417
HOUSTON TX
77082-2439
US

IV. Provider business mailing address

12121 RICHMOND AVE STE 417
HOUSTON TX
77082-2439
US

V. Phone/Fax

Practice location:
  • Phone: 281-597-1630
  • Fax: 281-531-9600
Mailing address:
  • Phone: 281-597-1630
  • Fax: 281-531-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: