Healthcare Provider Details

I. General information

NPI: 1740328343
Provider Name (Legal Business Name): ANITA ANN TRUDELL ANITA TRUDELL, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ SUITE 430, BOX 956928
LOS ANGELES CA
90095-6928
US

IV. Provider business mailing address

200 MEDICAL PLZ SUITE 430, BOX 956928
LOS ANGELES CA
90095-6928
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7274
  • Fax: 310-794-7436
Mailing address:
  • Phone: 310-794-7274
  • Fax: 310-794-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: