MEDICARE: MS. DYMON MARIE HANES CBD, CPD, CLES, CPE

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		CA

General Provider Information

NPI Number	:	1124730213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DYMON MARIE HANES CBD, CPD, CLES, CPE

Provider Business Mailing Address
First Line	:	4120 N EL DORADO ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-2105
Country	:	US
Telephone Number	:	209-610-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 N EL DORADO ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-2105
Country	:	US
Telephone Number	:	209-610-6999
Fax Number	:

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

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	12/20/2022

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