Healthcare Provider Details

I. General information

NPI: 1992255483
Provider Name (Legal Business Name): STORK & SPROUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LOCUST AVE
SOUTH SAN FRANCISCO CA
94080-2614
US

IV. Provider business mailing address

PO BOX 1657
BURLINGAME CA
94011-1657
US

V. Phone/Fax

Practice location:
  • Phone: 650-227-3223
  • Fax:
Mailing address:
  • Phone: 650-227-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY MAALONA
Title or Position: OWNER
Credential: IBCLC
Phone: 650-455-6024