MEDICARE: MS. AMY JANE JONESCO PCD (POSTPARTUM CERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1053978395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY JANE JONESCO PCD (POSTPARTUM CERT

Provider Business Mailing Address
First Line	:	304 LARSSON ST.
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6731
Country	:	US
Telephone Number	:	310-569-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 LARSSON ST.
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6731
Country	:	US
Telephone Number	:	310-569-5960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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