Provider Demographics
NPI:1396469599
Name:MARTIN, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MARTIN
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 1:2616 S LOOP W STE 100G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2638
Mailing Address - Country:US
Mailing Address - Phone:832-225-6680
Mailing Address - Fax:346-502-3579
Practice Address - Street 1:2616 S LOOP W STE 100G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2638
Practice Address - Country:US
Practice Address - Phone:832-225-6680
Practice Address - Fax:346-502-3579
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty