=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427737261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MODESTO BIRTH & BEYOND, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2023
-----------------------------------------------------
Last Update Date | 07/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 KIMBALL ST.
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95361-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-576-5450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 KIMBALL ST.
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95361-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-576-5450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | SHEILA DANIEL
-----------------------------------------------------
Credential | CD,PCD
-----------------------------------------------------
Telephone | 209-576-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------