Healthcare Provider Details

I. General information

NPI: 1851610661
Provider Name (Legal Business Name): TERESA A JARVIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 OLIVE ST
LOS ANGELES CA
90015
US

IV. Provider business mailing address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax:
Mailing address:
  • Phone: 213-747-5542
  • Fax: 213-746-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNP0153
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR 143584-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: