Healthcare Provider Details

I. General information

NPI: 1962253633
Provider Name (Legal Business Name): MONICA BLAKELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 N SHEPHERD DR
HOUSTON TX
77018-6410
US

IV. Provider business mailing address

7490 BROMPTON ST APT 409
HOUSTON TX
77025-2212
US

V. Phone/Fax

Practice location:
  • Phone: 713-699-4211
  • Fax:
Mailing address:
  • Phone: 469-468-2263
  • 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: