MEDICARE: JEANINE KANEZA DOULA

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		CA

General Provider Information

NPI Number	:	1326918368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE KANEZA DOULA

Provider Business Mailing Address
First Line	:	9591 MECEM CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4444
Country	:	US
Telephone Number	:	415-509-6243
Fax Number	:

Provider Business Practice Location Address
First Line	:	9591 MECEM CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4444
Country	:	US
Telephone Number	:	415-509-6243
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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