Provider Demographics
NPI:1568272367
Name:GRUNDY, LEOMA ROSE (DOULA)
Entity type:Individual
Prefix:
First Name:LEOMA
Middle Name:ROSE
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:GRUNDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1319 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1033
Mailing Address - Country:US
Mailing Address - Phone:510-499-9865
Mailing Address - Fax:
Practice Address - Street 1:1319 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1033
Practice Address - Country:US
Practice Address - Phone:510-499-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula