Basic Information
| Provider Information | |||||||||
| NPI: | 1912429309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTAYIB | ||||||||
| FirstName: | RUMAISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 CARIBOU HUNT TRL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328245670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342392740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4441 HOFFNER AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328122331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072184744 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 12012804A | IN | N | Dental Providers | Dentist | General Practice | 1223G0001X | 2901022278 | MI | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN24683 | FL | Y | Dental Providers | Dentist | General Practice |
No ID Information.