Healthcare Provider Details

I. General information

NPI: 1477788214
Provider Name (Legal Business Name): LAILA S TABATABAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SUNSET BLVD
HOUSTON TX
77005-1713
US

IV. Provider business mailing address

1701 SUNSET BLVD
HOUSTON TX
77005-1713
US

V. Phone/Fax

Practice location:
  • Phone: 713-526-5511
  • Fax: 713-520-4755
Mailing address:
  • Phone: 713-526-5511
  • Fax: 713-520-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberQ1031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: