Provider Demographics
NPI:1871030254
Name:LOBE, BERYL-ANNE TUFON
Entity Type:Individual
Prefix:
First Name:BERYL-ANNE
Middle Name:TUFON
Last Name:LOBE
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 1:8303 SOUTHWEST FWY STE 805
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1792
Mailing Address - Country:US
Mailing Address - Phone:281-530-1709
Mailing Address - Fax:281-530-1719
Practice Address - Street 1:8303 SOUTHWEST FWY STE 805
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1792
Practice Address - Country:US
Practice Address - Phone:281-530-1709
Practice Address - Fax:281-530-1719
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012235251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211583401Medicaid
TX747281Medicare PIN