Provider Demographics
NPI:1831570001
Name:BAMBO, HUSNA (MD)
Entity type:Individual
Prefix:DR
First Name:HUSNA
Middle Name:
Last Name:BAMBO
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 1:5870 HIATUS RD
Mailing Address - Street 2:REGIONAL ADMIN OFFICE - PE WEST
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:888-447-2362
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:METHODIST SPECIALTY AND TRANSPLANT HOSPITAL
Practice Address - Street 2:8026 FLOYD CURL DR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-575-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR7167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program