Healthcare Provider Details

I. General information

NPI: 1154296564
Provider Name (Legal Business Name): MISS WILLOW CATHERINE MIZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 COUNTRY MEADOW ST
MOORPARK CA
93021-2733
US

IV. Provider business mailing address

4332 COUNTRY MEADOW ST
MOORPARK CA
93021-2733
US

V. Phone/Fax

Practice location:
  • Phone: 805-627-4057
  • Fax:
Mailing address:
  • Phone: 805-627-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: