Healthcare Provider Details

I. General information

NPI: 1578706446
Provider Name (Legal Business Name): PACHAMAMA MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 BROWNS VALLEY RD
NAPA CA
94558-5422
US

IV. Provider business mailing address

3141 BROWNS VALLEY RD
NAPA CA
94558-5422
US

V. Phone/Fax

Practice location:
  • Phone: 707-251-9476
  • Fax:
Mailing address:
  • Phone: 707-251-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number229
License Number StateCA

VIII. Authorized Official

Name: KATE COLETTI
Title or Position: LICENSED MIDWIFE
Credential: LM.CPM
Phone: 707-483-7061