Healthcare Provider Details

I. General information

NPI: 1962610527
Provider Name (Legal Business Name): MAURA BRID DALY CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FAIRVIEW ST
OAKLAND CA
94609-1014
US

IV. Provider business mailing address

630 FAIRVIEW ST
OAKLAND CA
94609-1014
US

V. Phone/Fax

Practice location:
  • Phone: 551-804-1215
  • Fax:
Mailing address:
  • Phone: 551-804-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: