Provider Demographics
NPI:1750100400
Name:DOULAJUSTINALLC
Entity type:Organization
Organization Name:DOULAJUSTINALLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BUENROSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:BRITH DOULA
Authorized Official - Phone:909-201-4136
Mailing Address - Street 1:6576 GROTTO LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6576 GROTTO LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5558
Practice Address - Country:US
Practice Address - Phone:909-201-4136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty