Provider Demographics
NPI:1134742968
Name:BATAINEH, BASEL SR
Entity type:Individual
Prefix:
First Name:BASEL
Middle Name:
Last Name:BATAINEH
Suffix:SR
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 1:24200 SW FWY
Mailing Address - Street 2:SUIT# 402- 205
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471
Mailing Address - Country:US
Mailing Address - Phone:832-228-2328
Mailing Address - Fax:804-258-4933
Practice Address - Street 1:100 S 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3002
Practice Address - Country:US
Practice Address - Phone:832-228-2328
Practice Address - Fax:804-258-4933
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06897790172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver