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NPI Code Detail

MEDICARE: MITALEE JIVA

MEDICARE: MITALEE JIVA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP134185TX
2363LF0000XFamily Nurse Practitioner803122TX

General Provider Information

NPI Number : 1023533080
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITALEE JIVA
Provider Business Mailing Address
First Line : 1890 RESEARCH FOREST DR
Second Line :
City : SHENANDOAH
State : TX
Zip : 77381-4566
Country : US
Telephone Number : 832-658-3600
Fax Number : 713-897-7009
Provider Business Practice Location Address
First Line : 1890 RESEARCH FOREST DR
Second Line :
City : SHENANDOAH
State : TX
Zip : 77381-4566
Country : US
Telephone Number : 832-658-3600
Fax Number : 713-897-7009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 02/04/2026

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