Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | TEMPORARY | TX |
NPI | 1063452407 |
---|---|
Provider Name | Dr. Salam Izdain Gharaybeh |
First Address | Corpus Christi, TX 78411-6696 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1809345-03 | (05) | TX |
I55407 | (02) |