MEDICARE: STORK & SPROUT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)
2	374J00000X	Doula

General Provider Information

NPI Number	:	1992255483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STORK & SPROUT LLC

Provider Business Mailing Address
First Line	:	PO BOX 1657
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94011-1657
Country	:	US
Telephone Number	:	650-227-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 LOCUST AVE
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-2614
Country	:	US
Telephone Number	:	650-227-3223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTANY MAALONA
Credential	:	IBCLC
Telephone Number	:	650-455-6024

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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Directions to “STORK & SPROUT LLC ” Practice Location

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