Provider Demographics
NPI:1194587485
Name:GOODEN, KYIESHA NICOLE (PROFESSIONAL DOULA)
Entity type:Individual
Prefix:
First Name:KYIESHA
Middle Name:NICOLE
Last Name:GOODEN
Suffix:
Gender:F
Credentials:PROFESSIONAL DOULA
Other - Prefix:
Other - First Name:UNIQUE BIRTH
Other - Middle Name:EXPERIENCE
Other - Last Name:DOULAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROFESSIONAL DOULA
Mailing Address - Street 1:101 W MISSION BLVD # 110-268
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1711
Mailing Address - Country:US
Mailing Address - Phone:760-577-9337
Mailing Address - Fax:
Practice Address - Street 1:1370 N ST ANDREWS PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8529
Practice Address - Country:US
Practice Address - Phone:213-370-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula