Provider Demographics
NPI:1407396765
Name:AL-BANNA, SOPHIA
Entity Type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:
Last Name:AL-BANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 ARROWWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1400
Mailing Address - Country:US
Mailing Address - Phone:713-703-8485
Mailing Address - Fax:
Practice Address - Street 1:11645 ARROWWOOD CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1400
Practice Address - Country:US
Practice Address - Phone:713-703-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86065864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered