Healthcare Provider Details

I. General information

NPI: 1831766757
Provider Name (Legal Business Name): CIERRA AALIYAH HUDLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 RIVERSTONE BLVD
MISSOURI CITY TX
77459-4723
US

IV. Provider business mailing address

915 COLE AVE APT 2904
ROSENBERG TX
77471-3948
US

V. Phone/Fax

Practice location:
  • Phone: 346-275-2001
  • Fax: 855-742-3123
Mailing address:
  • Phone: 832-723-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: