Provider Demographics
NPI:1215250337
Name:ABRAHAM, TRAVONN B
Entity type:Individual
Prefix:
First Name:TRAVONN
Middle Name:B
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15607 GOLDEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2220
Mailing Address - Country:US
Mailing Address - Phone:832-788-7311
Mailing Address - Fax:
Practice Address - Street 1:15607 GOLDEN EAGLE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-2220
Practice Address - Country:US
Practice Address - Phone:832-788-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health