Provider Demographics
NPI:1457872228
Name:KHATTAB, INAS (LSA)
Entity Type:Individual
Prefix:
First Name:INAS
Middle Name:
Last Name:KHATTAB
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 PORTCHESTER CASTLE PATH
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4454
Mailing Address - Country:US
Mailing Address - Phone:916-756-7147
Mailing Address - Fax:512-381-4275
Practice Address - Street 1:1523 PORTCHESTER CASTLE PATH
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4454
Practice Address - Country:US
Practice Address - Phone:916-756-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112992207Q00000X
TXSA000858246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine