Provider Demographics
NPI:1104138569
Name:SCARBOROUGH, STACEY ANN (CCE, CD(DONA), CLE)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:CCE, CD(DONA), CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4794 WINONA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2004
Mailing Address - Country:US
Mailing Address - Phone:619-583-1129
Mailing Address - Fax:619-583-1129
Practice Address - Street 1:4794 WINONA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2004
Practice Address - Country:US
Practice Address - Phone:619-583-1129
Practice Address - Fax:619-583-1129
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374J00000XOtherNURSING SERVICES RELATED PROVIDER