Healthcare Provider Details

I. General information

NPI: 1184937823
Provider Name (Legal Business Name): NINA ZATIKYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ORCHARD ST STE 200
WEBSTER TX
77598-4146
US

IV. Provider business mailing address

501 ORCHARD ST STE 200
WEBSTER TX
77598-4146
US

V. Phone/Fax

Practice location:
  • Phone: 281-557-8555
  • Fax: 281-554-3657
Mailing address:
  • Phone: 281-557-8555
  • Fax: 281-554-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberQ5958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: