Healthcare Provider Details

I. General information

NPI: 1619768629
Provider Name (Legal Business Name): DOULA TE-RUK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 CASSIDY CIR
RIVERSIDE CA
92509-7123
US

IV. Provider business mailing address

8216 CASSIDY CIR
RIVERSIDE CA
92509-7123
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-4995
  • Fax:
Mailing address:
  • Phone: 619-522-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOUNISRA REID
Title or Position: OWNER
Credential:
Phone: 909-359-3169