Provider Demographics
NPI:1235943226
Name:BACICH, ALISON WONDERLAND (CPPD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:WONDERLAND
Last Name:BACICH
Suffix:
Gender:F
Credentials:CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3631
Mailing Address - Country:US
Mailing Address - Phone:562-774-3278
Mailing Address - Fax:
Practice Address - Street 1:860 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3631
Practice Address - Country:US
Practice Address - Phone:562-774-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula