Provider Demographics
NPI:1912734187
Name:GADDIES, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:GADDIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1747
Mailing Address - Country:US
Mailing Address - Phone:707-654-8007
Mailing Address - Fax:
Practice Address - Street 1:211 STANFORD DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1747
Practice Address - Country:US
Practice Address - Phone:707-654-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach