Provider Demographics
NPI:1285121046
Name:FREITAS, MARI E (DONA CERTIFIED)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:E
Last Name:FREITAS
Suffix:
Gender:F
Credentials:DONA CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FRONTERA WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5721
Mailing Address - Country:US
Mailing Address - Phone:650-245-8290
Mailing Address - Fax:
Practice Address - Street 1:2805 FRONTERA WAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5721
Practice Address - Country:US
Practice Address - Phone:650-245-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11247374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11247OtherDONA