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General NPI Number Information
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NPI Number | 1548081474
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Entity Type | Individual
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Provider Name | ELIAHKIM MAZO MABUTE NP
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Gender | Male
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 4645 SWEETWATER BLVD STE 200
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City | SUGAR LAND
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State | TX
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Zip | 77479-3016
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Country | US
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Telephone | 281-565-1112
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Fax | 281-565-1102
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Provider Business Mailing Address
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Address Line | 9779 FANNIN RAIL WAY APT 1115
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City | HOUSTON
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State | TX
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Zip | 77045-2254
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Country | US
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Telephone | 409-291-0002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 977911
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1232439
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License Number State | TX
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