Provider Demographics
NPI:1235811290
Name:SOUL SISTAH DOULA SERVICES
Entity Type:Organization
Organization Name:SOUL SISTAH DOULA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADIA
Authorized Official - Middle Name:NAKI
Authorized Official - Last Name:SHABAZZ-REGAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-881-5918
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1752
Mailing Address - Country:US
Mailing Address - Phone:760-900-5850
Mailing Address - Fax:760-628-2249
Practice Address - Street 1:12933 WALNUT WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-5569
Practice Address - Country:US
Practice Address - Phone:760-321-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMRA ENTERPRISE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty