MEDICARE: PACIFICA FAMILY MATERNITY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QB0400X	Birthing Clinic/Center		CA

General Provider Information

NPI Number	:	1770841843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFICA FAMILY MATERNITY CENTER

Provider Business Mailing Address
First Line	:	3101 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-1984
Country	:	US
Telephone Number	:	510-299-3760
Fax Number	:	510-299-3760

Provider Business Practice Location Address
First Line	:	3101 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-1984
Country	:	US
Telephone Number	:	510-299-3760
Fax Number	:	510-299-3760

Authorized Official
Title or Position	:	FOUNDER MIDWIFE
Name	:	CINDY HAAG
Credential	:
Telephone Number	:	510-299-3760

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	10/01/2012

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