Provider Demographics
NPI:1235911199
Name:KING, MILDRED (DOULA)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:MARLEE-I
Other - Middle Name:
Other - Last Name:MYSTIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOULA
Mailing Address - Street 1:849 JAMESTOWN AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3781
Mailing Address - Country:US
Mailing Address - Phone:415-676-8463
Mailing Address - Fax:
Practice Address - Street 1:849 JAMESTOWN AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3781
Practice Address - Country:US
Practice Address - Phone:415-676-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula