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General NPI Number Information
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NPI Number | 1194587485
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Entity Type | Individual
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Provider Name | KYIESHA NICOLE GOODEN PROFESSIONAL DOULA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 1370 N ST ANDREWS PL
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City | LOS ANGELES
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State | CA
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Zip | 90028-8529
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Country | US
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Telephone | 213-370-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W MISSION BLVD # 110-268
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City | POMONA
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State | CA
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Zip | 91766-1711
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Country | US
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Telephone | 760-577-9337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CA
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