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NPI Code Detail

MEDICARE: MONICA BLAKELY

MEDICARE:   MONICA  BLAKELY
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
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General Provider Information

NPI Number : 1962253633
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA BLAKELY
Provider Business Mailing Address
First Line : 7490 BROMPTON ST APT 409
Second Line :
City : HOUSTON
State : TX
Zip : 77025-2212
Country : US
Telephone Number : 469-468-2263
Fax Number :
Provider Business Practice Location Address
First Line : 3910 N SHEPHERD DR
Second Line :
City : HOUSTON
State : TX
Zip : 77018-6410
Country : US
Telephone Number : 713-699-4211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2024
Last Update Date : 03/29/2024

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Directions to “ MONICA BLAKELY ” Practice Location

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