Healthcare Provider Details

I. General information

NPI: 1184409450
Provider Name (Legal Business Name): QUILTED HEALTH CALIFORNIA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 ROSEMONT ST
LA JOLLA CA
92037-6061
US

IV. Provider business mailing address

1329 N 47TH ST UNIT 31112
SEATTLE WA
98103-6787
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 310-367-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: JENNA BENYOUNES
Title or Position: OWNER & SHAREHOLDER
Credential: ARNP, CNM
Phone: 703-531-9541