MEDICARE: MIRROREDHEART LLC

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	:	1285311035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRROREDHEART LLC

Provider Business Mailing Address
First Line	:	2190 EUCALYPTUS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-4519
Country	:	US
Telephone Number	:	626-678-7242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 EUCALYPTUS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-4519
Country	:	US
Telephone Number	:	562-294-0562
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	JASMINE GODINEZ-GOMEZ
Credential	:
Telephone Number	:	562-294-0562

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “MIRROREDHEART LLC ” Practice Location

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