Healthcare Provider Details

I. General information

NPI: 1942387469
Provider Name (Legal Business Name): ENDIA W BLADE CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

4027 BROWNSTONE LN
HOUSTON TX
77053-1406
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-7313
  • Fax:
Mailing address:
  • Phone: 713-434-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number53899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: