Provider Demographics
NPI:1518672534
Name:DAZA, KIRSTIE CATHERINE
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:CATHERINE
Last Name:DAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 OAK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1768
Mailing Address - Country:US
Mailing Address - Phone:510-993-5952
Mailing Address - Fax:
Practice Address - Street 1:1421 OAK HOLLOW CT
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1768
Practice Address - Country:US
Practice Address - Phone:510-993-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula