Provider Demographics
NPI:1073510533
Name:TAHA, SAMINA HABIB (MD)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:HABIB
Last Name:TAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24342 BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4742
Mailing Address - Country:US
Mailing Address - Phone:310-804-4013
Mailing Address - Fax:
Practice Address - Street 1:24342 BAXTER DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4742
Practice Address - Country:US
Practice Address - Phone:310-804-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200291208000000X
CAC54837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200200291OtherNC LICENSE #
CAC54837OtherCA LICENSE #
CAC54837OtherCA LICENSE #
NC200200291OtherNC LICENSE #