Provider Demographics
NPI:1043998370
Name:TERVOORT, MARISA (DOULA)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:TERVOORT
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 VIA DE PAZ
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-1374
Mailing Address - Country:US
Mailing Address - Phone:909-553-4616
Mailing Address - Fax:
Practice Address - Street 1:3014 VIA DE PAZ
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-1374
Practice Address - Country:US
Practice Address - Phone:909-553-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula