Healthcare Provider Details

I. General information

NPI: 1841964293
Provider Name (Legal Business Name): SAGE FANUCCHI-FUNES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 524
BERKELEY CA
94705-2120
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-0310
  • Fax: 510-244-0446
Mailing address:
  • Phone: 707-599-1533
  • Fax: 503-494-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM236401
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number202010801RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: