Healthcare Provider Details

I. General information

NPI: 1184221517
Provider Name (Legal Business Name): CYNTHIA L JEWETT LM CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26990 COUNTY ROAD 95A
DAVIS CA
95616-9443
US

IV. Provider business mailing address

358 COLLEGE AVE
ANGWIN CA
94508-9723
US

V. Phone/Fax

Practice location:
  • Phone: 917-544-6547
  • Fax:
Mailing address:
  • Phone: 917-544-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: