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General NPI Number Information
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NPI Number | 1861840944
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE KUBOTA-MISHRA D.O
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Gender | Female
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Dates
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Enumeration Date | 05/30/2016
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | MEDICAL OFFICE BUILDING, 5TH FLOOR 17580 INTERSTATE 45 SOUTH, WM 560
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City | THE WOODLANDS
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State | TX
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Zip | 77384
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Country | US
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Telephone | 936-267-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 6431 FANNIN ST MSB 3.151
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City | HOUSTON
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State | TX
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Zip | 77030-1501
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Country | US
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Telephone | 713-500-5800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R8927
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | R8927
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License Number State | TX
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