MEDICARE: AUDREY EARLEY DOULA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1114616737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY EARLEY DOULA

Provider Business Mailing Address
First Line	:	924 ENCINITAS BLVD APT 56
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-5393
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15644 POMERADO RD STE 302
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2455
Country	:	US
Telephone Number	:	858-278-2930
Fax Number	:	858-278-2943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ AUDREY EARLEY DOULA” Practice Location

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