Healthcare Provider Details

I. General information

NPI: 1427447101
Provider Name (Legal Business Name): SUSAN DEL BROCCOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 ADKINS RD
HOUSTON TX
77055-4450
US

IV. Provider business mailing address

1521 ADKINS RD
HOUSTON TX
77055-4450
US

V. Phone/Fax

Practice location:
  • Phone: 832-641-8771
  • Fax:
Mailing address:
  • Phone: 832-641-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: