Provider Demographics
NPI:1407082225
Name:HAITHAM JIFI-BAHLOOL
Entity Type:Organization
Organization Name:HAITHAM JIFI-BAHLOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-0112
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-991-0112
Mailing Address - Fax:361-991-0181
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-991-0112
Practice Address - Fax:361-991-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9719261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120623704Medicaid
TX120623704Medicaid