Healthcare Provider Details

I. General information

NPI: 1841906310
Provider Name (Legal Business Name): TALISHA J SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 ISABELLA ST
HOUSTON TX
77004-5446
US

IV. Provider business mailing address

20114 SORIA SPRINGS CIR
CYPRESS TX
77433-8202
US

V. Phone/Fax

Practice location:
  • Phone: 281-306-3388
  • Fax:
Mailing address:
  • Phone: 832-306-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT137206
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number808230
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: