Provider Demographics
NPI:1477788214
Name:TABATABAI, LAILA S (MD)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:S
Last Name:TABATABAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1713
Mailing Address - Country:US
Mailing Address - Phone:713-526-5511
Mailing Address - Fax:713-520-4755
Practice Address - Street 1:1701 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1713
Practice Address - Country:US
Practice Address - Phone:713-526-5511
Practice Address - Fax:713-520-4755
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ1031207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341444301Medicaid
TX8EQ262OtherBLUE CROSS BLUE SHIELD
TXP01403163OtherRR MEDICARE
TX341444301Medicaid