Provider Demographics
NPI:1376367557
Name:CALIFORNIA PERINATAL WELLNESS, INC
Entity type:Organization
Organization Name:CALIFORNIA PERINATAL WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDO-BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYED AMFT DOULA
Authorized Official - Phone:530-520-0928
Mailing Address - Street 1:655 MINNEWAWA AVE # 333
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1757
Mailing Address - Country:US
Mailing Address - Phone:530-520-0928
Mailing Address - Fax:
Practice Address - Street 1:1962 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3109
Practice Address - Country:US
Practice Address - Phone:530-520-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA PERINATAL WELLNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6172226OtherDOULA