Provider Demographics
NPI:1659839843
Name:ABDELHAFIZ, TARECK
Entity Type:Individual
Prefix:
First Name:TARECK
Middle Name:
Last Name:ABDELHAFIZ
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 1:11546 BROOK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5324
Mailing Address - Country:US
Mailing Address - Phone:832-375-9693
Mailing Address - Fax:
Practice Address - Street 1:11546 BROOK MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5324
Practice Address - Country:US
Practice Address - Phone:832-375-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse