Provider Demographics
NPI:1093238586
Name:NTAH, FELIX M
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:M
Last Name:NTAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 RUNNERS RDG
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3706
Mailing Address - Country:US
Mailing Address - Phone:512-487-9635
Mailing Address - Fax:
Practice Address - Street 1:2305 BAMBOO ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3465
Practice Address - Country:US
Practice Address - Phone:512-487-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201700129632343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)