Provider Demographics
NPI:1720814577
Name:BASS, MONIQUE (CD(DONA))
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11468 ALBERS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2846
Mailing Address - Country:US
Mailing Address - Phone:503-575-5956
Mailing Address - Fax:
Practice Address - Street 1:11468 ALBERS ST APT 4
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2846
Practice Address - Country:US
Practice Address - Phone:503-575-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1477888374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula