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General NPI Number Information
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NPI Number | 1043059579
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Entity Type | Organization
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Legal Business Name | DIVINE DOULAS
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 240 W 12TH ST
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City | PITTSBURG
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State | CA
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Zip | 94565-2461
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Country | US
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Telephone | 341-219-3472
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Fax |
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Provider Business Mailing Address
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Address Line | 2648 INTERNATIONAL BLVD STE 115
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City | OAKLAND
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State | CA
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Zip | 94601-1569
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Country | US
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Telephone | 510-213-8210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BREANNA GAY
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Credential |
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Telephone | 510-213-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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