Healthcare Provider Details

I. General information

NPI: 1659167997
Provider Name (Legal Business Name): ALIA KHAZAAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 BELLAIRE BLVD
BELLAIRE TX
77401-4527
US

IV. Provider business mailing address

1755 WYNDALE ST
HOUSTON TX
77030-4152
US

V. Phone/Fax

Practice location:
  • Phone: 205-253-7009
  • Fax:
Mailing address:
  • Phone: 205-253-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: