MEDICARE: JELYSE PATRICIA LANGSTON

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	:	1699600544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JELYSE PATRICIA LANGSTON

Provider Business Mailing Address
First Line	:	229 E GAGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E GAGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1533
Country	:	US
Telephone Number	:	951-616-0118
Fax Number	:

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

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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Directions to “ JELYSE PATRICIA LANGSTON ” Practice Location

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