Individual
MARIA PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5638 LAKE MURRAY BLVD STE 332, LA MESA, CA 91942-1929
(619) 481-8691
Mailing address
5638 LAKE MURRAY BLVD STE 332, LA MESA, CA 91942-1929
(619) 481-8691
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
374J00000X
Doula
Primary
—
—
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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