MEDICARE: RAICES LATINAS BIRTH SUPPORT LLC

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	:	1881545044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAICES LATINAS BIRTH SUPPORT LLC

Provider Business Mailing Address
First Line	:	1062 CAPITOL AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2212
Country	:	US
Telephone Number	:	415-672-1857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1062 CAPITOL AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2212
Country	:	US
Telephone Number	:	415-672-1857
Fax Number	:

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	AIMEE OLMOS
Credential	:
Telephone Number	:	415-672-1857

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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