Healthcare Provider Details

I. General information

NPI: 1326630062
Provider Name (Legal Business Name): NAYA ILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 FM 2920 RD
SPRING TX
77388-3428
US

IV. Provider business mailing address

11318 SARDINIA DR
RICHMOND TX
77406-5101
US

V. Phone/Fax

Practice location:
  • Phone: 281-210-1500
  • Fax: 281-210-1564
Mailing address:
  • Phone: 817-366-5437
  • 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: