Healthcare Provider Details

I. General information

NPI: 1477212892
Provider Name (Legal Business Name): EAST BAY MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 STANNAGE AVE
ALBANY CA
94706-2006
US

IV. Provider business mailing address

1516 GRANT ST
BERKELEY CA
94703-1134
US

V. Phone/Fax

Practice location:
  • Phone: 510-679-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEANNIE CHOE
Title or Position: PARTNER
Credential: LM, CPM, IBCLC
Phone: 510-679-1119