Healthcare Provider Details

I. General information

NPI: 1720400310
Provider Name (Legal Business Name): ROOTMAMA MATERNAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 MELEAR DR UNIT 151681
ARLINGTON TX
76015-4870
US

IV. Provider business mailing address

3903 MELEAR DR UNIT 151681
ARLINGTON TX
76015-4870
US

V. Phone/Fax

Practice location:
  • Phone: 682-587-7668
  • Fax:
Mailing address:
  • Phone: 682-587-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number001
License Number StateOR

VIII. Authorized Official

Name: MS. FELICIA MONTGOMERY
Title or Position: DOULA
Credential: C.D.
Phone: 202-270-1080