Healthcare Provider Details

I. General information

NPI: 1346761665
Provider Name (Legal Business Name): RAYVEN LEIGH BRIDGES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24022 CINCO VILLAGE CENTER BLVD STE 240
KATY TX
77494-3393
US

IV. Provider business mailing address

24022 CINCO VILLAGE CENTER BLVD STE 240
KATY TX
77494-3393
US

V. Phone/Fax

Practice location:
  • Phone: 832-376-8600
  • Fax: 832-376-8686
Mailing address:
  • Phone: 832-376-8600
  • Fax: 832-376-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: