Provider Demographics
NPI:1255075909
Name:AVALOS, STACY (DOULA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:AVALOS
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 1:1845 S BASCOM AVE APT B08
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2325
Mailing Address - Country:US
Mailing Address - Phone:415-723-6852
Mailing Address - Fax:
Practice Address - Street 1:1845 S BASCOM AVE APT B08
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2325
Practice Address - Country:US
Practice Address - Phone:415-723-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula