Healthcare Provider Details

I. General information

NPI: 1194600601
Provider Name (Legal Business Name): ITZEL PLIEGO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

IV. Provider business mailing address

2450 HOLCOMBE BLVD STE NB-34L
HOUSTON TX
77021-2039
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax:
Mailing address:
  • Phone: 832-828-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1201969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: