Provider Demographics
NPI:1043402662
Name:DOUGLASS, COLEY S (CPM)
Entity type:Individual
Prefix:
First Name:COLEY
Middle Name:S
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26128 OAKCREEK UNION DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8317
Mailing Address - Country:US
Mailing Address - Phone:951-662-1906
Mailing Address - Fax:
Practice Address - Street 1:26128 OAKCREEK UNION DR
Practice Address - Street 2:UNIT C
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8317
Practice Address - Country:US
Practice Address - Phone:951-662-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06110009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife