Healthcare Provider Details

I. General information

NPI: 1912158387
Provider Name (Legal Business Name): ALIYA NAAZ MUSHTAQ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S CONROE MEDICAL DR
CONROE TX
77304-5395
US

IV. Provider business mailing address

603 S CONROE MEDICAL DR
CONROE TX
77304-5395
US

V. Phone/Fax

Practice location:
  • Phone: 936-978-0466
  • Fax: 936-978-0469
Mailing address:
  • Phone: 936-978-0466
  • Fax: 936-978-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTMB PIT # BP10029038
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberP8954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: