Provider Demographics
NPI:1659443729
Name:SABABAKARE, TAIWO ADEREMI
Entity Type:Individual
Prefix:MR
First Name:TAIWO
Middle Name:ADEREMI
Last Name:SABABAKARE
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 1:9207 COUNTRY CREEK DR
Mailing Address - Street 2:205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7714
Mailing Address - Country:US
Mailing Address - Phone:713-777-4348
Mailing Address - Fax:713-777-3212
Practice Address - Street 1:9207 COUNTRY CREEK DR
Practice Address - Street 2:205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7714
Practice Address - Country:US
Practice Address - Phone:713-777-4348
Practice Address - Fax:713-777-3212
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0069182320600000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies