Healthcare Provider Details

I. General information

NPI: 1558182683
Provider Name (Legal Business Name): DOREEN ABLAKWA GIWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 WINCHESTER RANCH TRL
KATY TX
77493-3644
US

IV. Provider business mailing address

3310 WINCHESTER RANCH TRL
KATY TX
77493-3644
US

V. Phone/Fax

Practice location:
  • Phone: 832-682-6386
  • Fax:
Mailing address:
  • Phone: 832-682-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number311518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: