Provider Demographics
NPI:1750164810
Name:SIROKY, ANNIE GRACE (LM, CPM)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:GRACE
Last Name:SIROKY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3026
Mailing Address - Country:US
Mailing Address - Phone:805-667-2229
Mailing Address - Fax:805-852-2635
Practice Address - Street 1:3458 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3026
Practice Address - Country:US
Practice Address - Phone:805-667-2229
Practice Address - Fax:805-852-2635
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM721176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife