Provider Demographics
NPI:1073322970
Name:GONZALES, KAYLA MICHELLE (DOULA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:GONZALES
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 1:4157 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2207
Mailing Address - Country:US
Mailing Address - Phone:267-216-6978
Mailing Address - Fax:
Practice Address - Street 1:4157 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19140-2207
Practice Address - Country:US
Practice Address - Phone:267-216-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20069374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty