Provider Demographics
NPI:1376174375
Name:MAWANI, ALTAF
Entity Type:Individual
Prefix:
First Name:ALTAF
Middle Name:
Last Name:MAWANI
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 1:8227 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4602
Mailing Address - Country:US
Mailing Address - Phone:713-614-2895
Mailing Address - Fax:
Practice Address - Street 1:8227 JASMINE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4602
Practice Address - Country:US
Practice Address - Phone:713-614-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies