Healthcare Provider Details

I. General information

NPI: 1821232927
Provider Name (Legal Business Name): SALLY C. LANG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 SANTA FE DR SUITE 115
ENCINITAS CA
92024-5143
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5155
  • Fax: 760-633-6870
Mailing address:
  • Phone: 760-901-5155
  • Fax: 760-633-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN677770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: