Provider Demographics
NPI:1376217174
Name:VARVOUTIS, MARIA (CD, PCD, CLC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VARVOUTIS
Suffix:
Gender:F
Credentials:CD, PCD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 RESEDA DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2532
Mailing Address - Country:US
Mailing Address - Phone:727-742-1763
Mailing Address - Fax:
Practice Address - Street 1:26 VIA BUENA VIS
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6129
Practice Address - Country:US
Practice Address - Phone:727-742-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
333654174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula