=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316967235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YALAD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 E EVERGREEN ST
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-377-0707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 691327
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78269-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-377-0707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. JENNIFER KELLEHER
-----------------------------------------------------
Credential | CPM, LM
-----------------------------------------------------
Telephone | 210-377-0707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 05002
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------