Provider Demographics
NPI:1295191948
Name:CARLONE, MIA G (DOULA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:G
Last Name:CARLONE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1912
Mailing Address - Country:US
Mailing Address - Phone:510-703-0970
Mailing Address - Fax:
Practice Address - Street 1:2906 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1912
Practice Address - Country:US
Practice Address - Phone:510-703-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor