Healthcare Provider Details

I. General information

NPI: 1023533080
Provider Name (Legal Business Name): MITALEE JIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 SARATOGA BLVD STE 320
CORPUS CHRISTI TX
78414-4103
US

IV. Provider business mailing address

909 FROSTWOOD DR STE 1.100
HOUSTON TX
77024-2301
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-1600
  • Fax:
Mailing address:
  • Phone: 713-338-5519
  • Fax: 713-704-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134185
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number803122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: