MEDICARE: TERIYA MONICK RICHMOND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N7335	TX

General Provider Information

NPI Number	:	1649413329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERIYA MONICK RICHMOND MD

Provider Business Mailing Address
First Line	:	5751 BLYTHEWOOD ST
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-5404
Country	:	US
Telephone Number	:	832-215-5985
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 BLYTHEWOOD ST
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-5404
Country	:	US
Telephone Number	:	832-215-5985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	04/20/2020

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