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General NPI Number Information
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NPI Number | 1487129987
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Entity Type | Individual
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Provider Name | BEVERLY JEAN KETCHUM C.P.D. C.L.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 4725 W 163RD ST
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City | LAWNDALE
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State | CA
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Zip | 90260-2822
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Country | US
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Telephone | 424-240-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 4756 W 163RD ST
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City | LAWNDALE
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State | CA
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Zip | 90260-2821
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Country | US
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Telephone | 424-240-6505
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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 | 2012-257
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License Number State | CA
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