Provider Demographics
NPI:1558465757
Name:TALIEH, LEILA
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:TALIEH
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 1:915 GESSNER RD
Mailing Address - Street 2:870
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2557
Mailing Address - Country:US
Mailing Address - Phone:713-465-6198
Mailing Address - Fax:713-465-6919
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:870
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2557
Practice Address - Country:US
Practice Address - Phone:713-465-6198
Practice Address - Fax:713-465-6919
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0970931-02Medicaid
G22116Medicare UPIN
00949JMedicare PIN