Healthcare Provider Details

I. General information

NPI: 1013888106
Provider Name (Legal Business Name): KRYSTAL MELESSIA SINGH DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MOUNT DIABLO ST
PERRIS CA
92570-1824
US

IV. Provider business mailing address

19510 VAN BUREN BLVD STE F3 PMB 152
RIVERSIDE CA
92508
US

V. Phone/Fax

Practice location:
  • Phone: 951-712-5031
  • Fax:
Mailing address:
  • Phone: 951-712-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: