Provider Demographics
NPI:1902696149
Name:DALTON, MALISA ANN
Entity type:Individual
Prefix:
First Name:MALISA
Middle Name:ANN
Last Name:DALTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 HOLLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-1012
Mailing Address - Country:US
Mailing Address - Phone:713-440-9481
Mailing Address - Fax:
Practice Address - Street 1:8111 CORINTH ST APT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-1598
Practice Address - Country:US
Practice Address - Phone:346-237-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies