Provider Demographics
NPI:1942710819
Name:TYEHIMBA-FORD, OLOYA PHILAE' (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:OLOYA
Middle Name:PHILAE'
Last Name:TYEHIMBA-FORD
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 SHADDICK DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5044
Mailing Address - Country:US
Mailing Address - Phone:510-691-5169
Mailing Address - Fax:
Practice Address - Street 1:623 SHADDICK DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5044
Practice Address - Country:US
Practice Address - Phone:510-691-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175M00000X, 374J00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175M00000XOther Service ProvidersMidwife, Lay
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99501Medicaid
CA99502Medicaid
CA99499Medicaid