Provider Demographics
NPI:1750843900
Name:NOORILY, TALIA JAYNE
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:JAYNE
Last Name:NOORILY
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 1:2455 DUNSTAN RD APT 423
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2307
Mailing Address - Country:US
Mailing Address - Phone:210-289-4020
Mailing Address - Fax:
Practice Address - Street 1:18707 HARDY OAK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4792
Practice Address - Country:US
Practice Address - Phone:210-692-3000
Practice Address - Fax:210-692-3056
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5470207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology