Healthcare Provider Details

I. General information

NPI: 1366153439
Provider Name (Legal Business Name): ROSA SIERRA CPD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MILNERFIELD RD
JOHNSTON RI
02919-1479
US

IV. Provider business mailing address

13 MILNERFIELD RD
PROVIDENCE RI
02919-1479
US

V. Phone/Fax

Practice location:
  • Phone: 401-617-7473
  • Fax:
Mailing address:
  • Phone: 401-617-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number2201058
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: