Provider Demographics
NPI:1447735899
Name:ZOUROB, HABEBA (NUTRITIONST)
Entity Type:Individual
Prefix:
First Name:HABEBA
Middle Name:
Last Name:ZOUROB
Suffix:
Gender:F
Credentials:NUTRITIONST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1130
Mailing Address - Country:US
Mailing Address - Phone:734-845-0076
Mailing Address - Fax:
Practice Address - Street 1:7252 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1130
Practice Address - Country:US
Practice Address - Phone:734-845-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid