Healthcare Provider Details

I. General information

NPI: 1770533069
Provider Name (Legal Business Name): ANDREA PFEFFER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST
OAKLAND CA
94609-3425
US

IV. Provider business mailing address

350 30TH ST SUITE 205
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-0790
  • Fax:
Mailing address:
  • Phone: 510-444-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: