Healthcare Provider Details

I. General information

NPI: 1689908113
Provider Name (Legal Business Name): JANNAH FIRDAOUS ALAOUI CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-4101
  • Fax: 413-796-6821
Mailing address:
  • Phone: 760-736-6700
  • Fax: 760-736-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2270047
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: