Healthcare Provider Details

I. General information

NPI: 1043799604
Provider Name (Legal Business Name): MIATTA SIRLEAF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14950 HEATHROW FOREST PKWY STE 250
HOUSTON TX
77032-3845
US

IV. Provider business mailing address

7515 CYPRESS BLUFF DR
CYPRESS TX
77433-1726
US

V. Phone/Fax

Practice location:
  • Phone: 281-921-2301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number185223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: