Provider Demographics
NPI:1891181434
Name:TALABI, TAIWO
Entity Type:Individual
Prefix:
First Name:TAIWO
Middle Name:
Last Name:TALABI
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 1:11490 HARWIN DR APT 522
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1463
Mailing Address - Country:US
Mailing Address - Phone:281-899-9397
Mailing Address - Fax:713-780-8883
Practice Address - Street 1:11490 HARWIN DR APT 522
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1463
Practice Address - Country:US
Practice Address - Phone:281-899-9397
Practice Address - Fax:713-780-8883
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18154566172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver