Provider Demographics
NPI:1376421719
Name:MOREANO, JESSICA (CERTIFIED DOULA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MOREANO
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PILGRIM WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4042
Mailing Address - Country:US
Mailing Address - Phone:415-286-8877
Mailing Address - Fax:
Practice Address - Street 1:14 PILGRIM WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4042
Practice Address - Country:US
Practice Address - Phone:415-286-8877
Practice Address - Fax:415-286-8877
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula