Healthcare Provider Details

I. General information

NPI: 1417956327
Provider Name (Legal Business Name): MARCIA OKAWA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 TALBERT AVE
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

1665 SCENIC AVE. SUITE 100
COSTA MESA CA
92626
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-6443
  • Fax:
Mailing address:
  • Phone: 310-782-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number276481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: