Healthcare Provider Details

I. General information

NPI: 1033596259
Provider Name (Legal Business Name): FABULOUS BIRTH SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 8TH AVE APT 4N
NEW YORK NY
10030-1536
US

IV. Provider business mailing address

2655 8TH AVE APT 4N
NEW YORK NY
10030-1536
US

V. Phone/Fax

Practice location:
  • Phone: 562-774-3289
  • Fax:
Mailing address:
  • Phone: 562-774-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ALISON WONDERLAND BACICH
Title or Position: FOUNDING DIRECTOR AND DOULA
Credential: CLC
Phone: 562-774-3289