Healthcare Provider Details

I. General information

NPI: 1881523967
Provider Name (Legal Business Name): MRS. KELLY IUCULANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 N ISABEL ST
GLENDALE CA
91207-1748
US

IV. Provider business mailing address

1119 N ISABEL ST
GLENDALE CA
91207-1748
US

V. Phone/Fax

Practice location:
  • Phone: 707-499-1212
  • Fax:
Mailing address:
  • Phone: 707-499-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: