MEDICARE: PRINCESS ESTOCIA SIERRA MCKINNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		CA

General Provider Information

NPI Number	:	1124568779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS ESTOCIA SIERRA MCKINNEY

Provider Business Mailing Address
First Line	:	3707 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-2569
Country	:	US
Telephone Number	:	844-692-3554
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 E SOUTHERN AVE STE 1013
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6201
Country	:	US
Telephone Number	:	844-692-3554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	09/20/2022

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