Provider Demographics
NPI:1982962114
Name:SOARES, KIRSTIN L (LM, CPM)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:L
Last Name:SOARES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-0108
Mailing Address - Country:US
Mailing Address - Phone:925-577-1268
Mailing Address - Fax:
Practice Address - Street 1:1545 WAGONER DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5815
Practice Address - Country:US
Practice Address - Phone:925-577-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327176B00000X
TX99139176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife