Provider Demographics
NPI:1215642418
Name:JACONETTY, NATALIE ELAINE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ELAINE
Last Name:JACONETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5105
Mailing Address - Country:US
Mailing Address - Phone:773-726-1208
Mailing Address - Fax:
Practice Address - Street 1:1341 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5105
Practice Address - Country:US
Practice Address - Phone:773-726-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula