Provider Demographics
NPI:1366884256
Name:ZAMBEZI, TALIB HASHIM
Entity type:Individual
Prefix:MR
First Name:TALIB
Middle Name:HASHIM
Last Name:ZAMBEZI
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 1:2305 SW H AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8103
Mailing Address - Country:US
Mailing Address - Phone:580-699-8553
Mailing Address - Fax:
Practice Address - Street 1:2305 SW H AVE
Practice Address - Street 2:1
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8103
Practice Address - Country:US
Practice Address - Phone:580-699-8551
Practice Address - Fax:580-699-8553
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation