Healthcare Provider Details

I. General information

NPI: 1437462355
Provider Name (Legal Business Name): NOVA MIDWIFERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 COLLEGE AVE STE C
OAKLAND CA
94618-2822
US

IV. Provider business mailing address

5290 COLLEGE AVE STE C
OAKLAND CA
94618-2822
US

V. Phone/Fax

Practice location:
  • Phone: 925-487-0690
  • Fax: 510-655-5572
Mailing address:
  • Phone:
  • Fax: 510-655-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number135
License Number StateCA

VIII. Authorized Official

Name: MASON M CORNELIUS
Title or Position: PARTNER
Credential: LM
Phone: 925-487-0690