Healthcare Provider Details

I. General information

NPI: 1477384303
Provider Name (Legal Business Name): HABIBA QUDRATULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8026 FLOYD CURL DR
SAN ANTONIO TX
78229-3915
US

IV. Provider business mailing address

8267 ELMBROOK DR STE 101
DALLAS TX
75247-4051
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: