Healthcare Provider Details

I. General information

NPI: 1053138669
Provider Name (Legal Business Name): DORIS IZUWAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 FRY RD STE 701
CYPRESS TX
77433-7850
US

IV. Provider business mailing address

4936 STEEPLE CHASE CT
GRAND PRAIRIE TX
75052-4598
US

V. Phone/Fax

Practice location:
  • Phone: 281-815-5033
  • Fax: 281-815-8537
Mailing address:
  • Phone: 945-244-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number8025
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: