Healthcare Provider Details

I. General information

NPI: 1083721146
Provider Name (Legal Business Name): MICHELLE HABASH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7703 FLOYD CURL DR # MC7977
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-743-2100
  • Fax: 210-702-6215
Mailing address:
  • Phone: 210-450-9000
  • Fax: 210-450-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2916
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberK2916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: