Provider Demographics
NPI:1356514137
Name:GIRON, VENESSA ROSE (CPM, LM)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:ROSE
Last Name:GIRON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 S JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-6507
Mailing Address - Country:US
Mailing Address - Phone:817-727-5529
Mailing Address - Fax:817-926-6808
Practice Address - Street 1:2945 S JENNINGS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-6507
Practice Address - Country:US
Practice Address - Phone:817-727-5529
Practice Address - Fax:817-926-6808
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99033176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife