=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104591338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROJECT TEENBIRTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2021
-----------------------------------------------------
Last Update Date | 08/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 SOMERSTONE DR
-----------------------------------------------------
City | VALRICO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33594-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-573-2445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4281
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33509-4281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-820-1660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOULA/PRESIDENT/FOUNDER
-----------------------------------------------------
Name | MELINDA D MORALES
-----------------------------------------------------
Credential | DOULA, COPE
-----------------------------------------------------
Telephone | 813-573-2445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------