Provider Demographics
NPI:1659514131
Name:MAHDAVINIA, MAHBOOBEH
Entity type:Individual
Prefix:
First Name:MAHBOOBEH
Middle Name:
Last Name:MAHDAVINIA
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 1:6431 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6838
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 720
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5205
Practice Address - Country:US
Practice Address - Phone:713-486-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0033207RA0201X
IL036-127466207RA0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology