Healthcare Provider Details

I. General information

NPI: 1336407907
Provider Name (Legal Business Name): PACIFICA FAMILY MATERNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 FULTON ST APT B
BERKELEY CA
94705-1845
US

IV. Provider business mailing address

3024 FULTON ST APT B
BERKELEY CA
94705-1845
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-8366
  • Fax: 510-704-8366
Mailing address:
  • Phone: 510-704-8366
  • Fax: 510-704-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: CINDY HAAG
Title or Position: FOUNDER MIDWIFE
Credential:
Phone: 510-704-8366