MEDICARE: JESSICA OSOWSKY BIRTH 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		CA

General Provider Information

NPI Number	:	1790374551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA OSOWSKY BIRTH DOULA

Provider Business Mailing Address
First Line	:	2600 GRANT AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3827
Country	:	US
Telephone Number	:	310-721-5308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 GRANT AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3827
Country	:	US
Telephone Number	:	310-721-5308
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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