Provider Demographics
NPI:1114625746
Name:MISS MARY'S DOULA SERVICE
Entity Type:Organization
Organization Name:MISS MARY'S DOULA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:JENNINGS MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-318-5190
Mailing Address - Street 1:8327 WHELAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1908
Mailing Address - Country:US
Mailing Address - Phone:619-318-5190
Mailing Address - Fax:
Practice Address - Street 1:8327 WHELAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1908
Practice Address - Country:US
Practice Address - Phone:619-318-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty