Provider Demographics
NPI:1689442634
Name:MINDFUL MATERNITY SERVICES WITH ANDREA, LLC
Entity Type:Organization
Organization Name:MINDFUL MATERNITY SERVICES WITH ANDREA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED DOULA AND WELLNESS COACH
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, CD
Authorized Official - Phone:703-795-8566
Mailing Address - Street 1:3903 W 182ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4849
Mailing Address - Country:US
Mailing Address - Phone:703-795-8566
Mailing Address - Fax:
Practice Address - Street 1:3903 W 182ND ST APT 1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4849
Practice Address - Country:US
Practice Address - Phone:703-795-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty