Healthcare Provider Details

I. General information

NPI: 1497355507
Provider Name (Legal Business Name): PHEBE BUBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12223 SALT RIVER VALLEY LN
HUMBLE TX
77346-2967
US

IV. Provider business mailing address

12223 SALT RIVER VALLEY LN
HUMBLE TX
77346-2967
US

V. Phone/Fax

Practice location:
  • Phone: 832-418-9652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number41636
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: