Provider Demographics
NPI:1639995756
Name:CORREA, MARISTELA MAMEDE (CPPD)
Entity type:Individual
Prefix:
First Name:MARISTELA
Middle Name:MAMEDE
Last Name:CORREA
Suffix:
Gender:F
Credentials:CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 VINCENTE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1521
Mailing Address - Country:US
Mailing Address - Phone:415-410-4140
Mailing Address - Fax:
Practice Address - Street 1:579 VINCENTE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1521
Practice Address - Country:US
Practice Address - Phone:415-410-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula