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General NPI Number Information
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NPI Number | 1609647882
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Entity Type | Organization
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Legal Business Name | HERITAGE MATERNITY SERVICES
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 10387 TAYLOR RD
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City | BRYAN
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State | TX
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Zip | 77808-4139
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Country | US
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Telephone | 979-571-4490
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Fax | 979-318-3477
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Provider Business Mailing Address
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Address Line | 10387 TAYLOR RD
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City | BRYAN
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State | TX
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Zip | 77808-4139
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Country | US
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Telephone | 979-571-4490
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Fax |
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Authorized Official
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Title or Position | FOUNDER/ DIRECTOR
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Name | MRS. ERIN REYNOSO
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Credential | LM, CPM
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Telephone | 979-571-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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