Provider Demographics
NPI:1619064953
Name:HABASHY, TAHANY MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:TAHANY
Middle Name:MAURICE
Last Name:HABASHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WEST MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7711
Mailing Address - Country:US
Mailing Address - Phone:714-730-0060
Mailing Address - Fax:714-730-0061
Practice Address - Street 1:222 WEST MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7711
Practice Address - Country:US
Practice Address - Phone:714-730-0060
Practice Address - Fax:714-730-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A653380Medicaid
CAA65338Medicare ID - Type Unspecified
CA00A653380Medicaid