Provider Demographics
NPI:1588100457
Name:SALEHA FAMILY PRACTICE
Entity type:Organization
Organization Name:SALEHA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:713-861-7773
Mailing Address - Street 1:707 AZALEADELL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-4417
Mailing Address - Country:US
Mailing Address - Phone:979-255-2591
Mailing Address - Fax:
Practice Address - Street 1:1631 NORTH LOOP W STE 480
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1548
Practice Address - Country:US
Practice Address - Phone:713-861-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132139261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care