Healthcare Provider Details

I. General information

NPI: 1679368062
Provider Name (Legal Business Name): JEANNETTE MOYNIHAN RN, IBCLC, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S ELM DR APT 6
BEVERLY HILLS CA
90212-4619
US

IV. Provider business mailing address

320 S ELM DR APT 6
BEVERLY HILLS CA
90212-4619
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-6071
  • Fax:
Mailing address:
  • Phone: 310-497-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-316656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: