Provider Demographics
NPI:1740824655
Name:MARTIN, MILIZZA
Entity type:Individual
Prefix:
First Name:MILIZZA
Middle Name:
Last Name:MARTIN
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 1:20303 RANCH RIATA DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2051
Mailing Address - Country:US
Mailing Address - Phone:281-690-0264
Mailing Address - Fax:
Practice Address - Street 1:532 W NASA PKWY
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5127
Practice Address - Country:US
Practice Address - Phone:281-724-1423
Practice Address - Fax:281-724-1425
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily