MEDICARE: MRS. BRENDA ESTEFANY GRANADOS

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	374J00000X	Doula		MD

General Provider Information

NPI Number	:	1306781034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA ESTEFANY GRANADOS

Provider Business Mailing Address
First Line	:	407 SUSSEX DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-2031
Country	:	US
Telephone Number	:	443-823-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 SUSSEX DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-2031
Country	:	US
Telephone Number	:	443-823-7317
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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