Provider Demographics
NPI:1467229211
Name:BOULDS, MARTESHA
Entity Type:Individual
Prefix:
First Name:MARTESHA
Middle Name:
Last Name:BOULDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 DAYLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1403
Mailing Address - Country:US
Mailing Address - Phone:713-391-4119
Mailing Address - Fax:
Practice Address - Street 1:16712 HUFFMEISTER RD BLDG 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8050
Practice Address - Country:US
Practice Address - Phone:281-746-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-2288882080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics