Healthcare Provider Details

I. General information

NPI: 1659209062
Provider Name (Legal Business Name): DRAGONFLYDOULA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 MAKATI CIR
SAN JOSE CA
95123-6233
US

IV. Provider business mailing address

5555 MAKATI CIR
SAN JOSE CA
95123-6233
US

V. Phone/Fax

Practice location:
  • Phone: 510-458-3121
  • Fax:
Mailing address:
  • Phone: 510-458-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA JAGER
Title or Position: OWNER OPERATOR
Credential:
Phone: 510-458-3121