Healthcare Provider Details

I. General information

NPI: 1265939565
Provider Name (Legal Business Name): MYLISA MOSES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST STE 275
WEBSTER TX
77598-4241
US

IV. Provider business mailing address

24 GREENWAY PLZ STE 1800
HOUSTON TX
77046-2457
US

V. Phone/Fax

Practice location:
  • Phone: 832-569-0707
  • Fax:
Mailing address:
  • Phone: 832-569-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU1972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: