Provider Demographics
NPI:1568580058
Name:AYUB, ILIA (LSA)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:
Last Name:AYUB
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14947 CAMINO RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3222
Mailing Address - Country:US
Mailing Address - Phone:713-823-0197
Mailing Address - Fax:713-823-0197
Practice Address - Street 1:14947 CAMINO RANCHO DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3222
Practice Address - Country:US
Practice Address - Phone:713-823-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00329246ZC0007X, 246ZS0410X
TX2947246ZS0410X
TX1012927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist