Individual
KELLY LAROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1751 NEWBURG RD, FORTUNA, CA 95540-2611
(707) 702-1443
Mailing address
PO BOX 160, BAYSIDE, CA 95524-0160
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Enumeration date
01/17/2026
Last updated
01/17/2026
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