Healthcare Provider Details

I. General information

NPI: 1891417648
Provider Name (Legal Business Name): RAVEN DANIELLE YEARGIN LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 02/10/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42585 GIBBEL RD
HEMET CA
92544-9255
US

IV. Provider business mailing address

3777 W. FLORIDA AVE. SUITE #21
HEMET CA
92545
US

V. Phone/Fax

Practice location:
  • Phone: 909-834-7353
  • Fax:
Mailing address:
  • Phone: 909-834-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: