Healthcare Provider Details

I. General information

NPI: 1730465949
Provider Name (Legal Business Name): NADINE CORBIN C.S.A.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 FM2920 #611
SPRING TX
77379
US

IV. Provider business mailing address

1958 SUGAR PINE CIR
HOUSTON TX
77090-3628
US

V. Phone/Fax

Practice location:
  • Phone: 281-748-1892
  • Fax: 281-586-9141
Mailing address:
  • Phone: 281-748-1892
  • Fax: 281-586-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00452
License Number StateTX

VIII. Authorized Official

Name: NADINE CORBIN
Title or Position: PRESIDENT
Credential: LSA
Phone: 281-748-1892