Healthcare Provider Details

I. General information

NPI: 1730003682
Provider Name (Legal Business Name): RAICES MATERNAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 JONKER WAY
HOLLAND MI
49424-7619
US

IV. Provider business mailing address

11760 JONKER WAY
HOLLAND MI
49424-7619
US

V. Phone/Fax

Practice location:
  • Phone: 734-743-1102
  • Fax:
Mailing address:
  • Phone: 734-743-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JAEL MARTHA GOVEA
Title or Position: OWNER
Credential: CLD
Phone: 734-743-1102