Provider Demographics
NPI:1376158824
Name:MIRZA, OWAIS
Entity type:Individual
Prefix:
First Name:OWAIS
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 BERKLEY KNOLL CIR APT 6101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3343
Mailing Address - Country:US
Mailing Address - Phone:832-810-0200
Mailing Address - Fax:
Practice Address - Street 1:25319 INTERSTATE 45 STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3551
Practice Address - Country:US
Practice Address - Phone:832-810-0200
Practice Address - Fax:888-682-7273
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009127163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse