Provider Demographics
NPI:1013894492
Name:BLACK, MEAGAN ESTRELLA (PCD, DONA)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:ESTRELLA
Last Name:BLACK
Suffix:
Gender:F
Credentials:PCD, DONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4724
Mailing Address - Country:US
Mailing Address - Phone:310-873-8873
Mailing Address - Fax:
Practice Address - Street 1:647 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4724
Practice Address - Country:US
Practice Address - Phone:310-873-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1497571374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula