Healthcare Provider Details

I. General information

NPI: 1922573393
Provider Name (Legal Business Name): SHERRIE LEGENDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11970 OLD RIVER SCHOOL RD APT 17
DOWNEY CA
90242-2168
US

IV. Provider business mailing address

11970 OLD RIVER SCHOOL RD APT 17
DOWNEY CA
90242-2168
US

V. Phone/Fax

Practice location:
  • Phone: 323-983-3229
  • Fax:
Mailing address:
  • Phone: 323-983-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number692
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: