Provider Demographics
NPI:1427929140
Name:THE DISTINGUISHED DOULA LLC
Entity type:Organization
Organization Name:THE DISTINGUISHED DOULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED LACTATION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:CLC, PCD(DONA)
Authorized Official - Phone:661-367-1136
Mailing Address - Street 1:160 CORSON ST APT 222
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3860
Mailing Address - Country:US
Mailing Address - Phone:661-367-1136
Mailing Address - Fax:
Practice Address - Street 1:160 CORSON ST APT 222
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3860
Practice Address - Country:US
Practice Address - Phone:661-367-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty