MEDICARE: HALEY MATTIZA

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
1	363LG0600X	Gerontology Nurse Practitioner	AP142358	TX

General Provider Information

NPI Number	:	1356005219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY MATTIZA

Provider Business Mailing Address
First Line	:	12519 RANDY RILEY WAY
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77377-9134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10318 LAKE RD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1874
Country	:	US
Telephone Number	:	281-847-6300
Fax Number	:	281-847-6301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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Directions to “ HALEY MATTIZA ” Practice Location

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